2026 American Academy of Neurology Abstract Website

Objective:

To evaluate the association between once-nightly pregabalin use and changes in nightmare frequency, restorative sleep, headache frequency, severity, duration, and disability scores in patients with nightmare, nonrestorative sleep, and headaches.

Background:

Nightmares, nonrestorative sleep, and headaches co-occur, are common, underdiagnosed, and contribute to substantial disability. Pregabalin’s effect on nightmares has not been systematically studied. Sedation is a common side effect when prescribed 2-3 times daily according to the package insert, but the literature assessing once nightly use is sparse.

Design/Methods:

Our retrospective case series included 23 patients prescribed once nightly pregabalin for nightmares, nonrestorative sleep, and headaches. Clinical data were extracted from medical records, including nightmare frequency, fraction of 24-hour periods with restorative sleep, headache frequency, severity, and duration, and Migraine Disability Assessment Questionnaire (MIDAS) scores. Within-subject pre–post comparisons were performed using paired t-tests or Wilcoxon signed-rank tests. All p-values were Holm–Bonferroni adjusted.

Results:

Nightmare frequency decreased 81% (17.5 to 3.3/month, p_adj=.006). 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=.006). Headache frequency decreased 50% (17.0 to 8.5/month, p_adj=.040). Migraine Disability Assessment Questionnaire (MIDAS) scores decreased numerically by 35% (44.0 to 24.5) but did not reach statistical significance after correction (p_adj=.084). Six patients reported side effects, and 19 continued pregabalin at three months.

Conclusions:

Once nightly pregabalin use was associated with robust reductions in nightmare frequency, nonrestorative sleep, and headache frequency. The reduction in nightmares is a novel finding. 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. Larger controlled studies are needed to test the hypothesis that once nightly pregabalin may be a useful treatment for this patient population.