Once-Nightly Pregabalin for Co-Occurring Nightmares, Poor Sleep, and Headaches: A Case Series.
Once-nightly pregabalin associated with 81% lower nightmare frequency in case series.
Once-Nightly Pregabalin for Co-Occurring Nightmares, Poor Sleep, and Headaches: A Case Series.
Nightmares, nonrestorative sleep, and headaches co-occur, are common, underdiagnosed, and contribute to substantial disability.
Our retrospective case series included 23 outpatients seen in the neurology department of a tertiary care center from November 2022 to August 2025.
Nightmares decreased numerically more for those who transitioned from gabapentin to pregabalin (91%) than for those not initially taking gabapentin (73%).
Restorative sleep frequency increased 127% (1.8 to 4.0/week, p adj =0.006).
Headache frequency decreased 50% (17.0 to 8.5/month, p adj =0.040).
Migraine Disability Assessment Questionnaire scores decreased numerically by 34% (38.0 to 24.0) but did not reach statistical significance after correction (p adj =0.084).
Once-nightly pregabalin was associated with robust reductions in nightmare frequency, nonrestorative sleep, and headache frequency. The improvement in nightmares validates two prior case reports through systematic cohort evaluation.
Nightmares improved even among patients transitioning from gabapentin to pregabalin, suggesting that pregabalin may be superior to gabapentin. No prior studies have addressed these three co-occurring problems simultaneously.