A Common Medication May Ease a Neglected Trio: Nightmares, Unrefreshing Sleep and Headaches

Nightmares, poor-quality sleep and headaches often coexist, yet this triad is frequently overlooked. Currently, nightmare disorders affect 4% of adults and significantly impair quality of life. However, nightmares remain underdiagnosed and underreported in clinical practice. 

A new study from the University of Arizona College of Medicine – Phoenix suggests that a single nightly dose of pregabalin, a medication already widely used for pain and seizures, may help with all three at once.  

James Bates, a fourth-year medical student at the U of A College of Medicine – Phoenix, was first author for this first-ever systematic case series of once-nightly pregabalin for nightmares. Sophia Rosin, an undergraduate student at the University of Michigan, served as a co-author for the study.

Bates’ retrospective case series examined what happened when patients with nightmares, non-restorative sleep and headaches were prescribed pregabalin. The study focused on 23 such patients seen in the neurology department from 2022 to 2025 by his mentor Joshua A. Tobin, MD, co-director of the Neurology Clerkship and a clinical professor of Neurology at the College of Medicine – Phoenix.

“We knew from existing research that patients with poor sleep tend to experience headaches,” Bates said. “Maybe nightmares are causing poor sleep, which makes headaches worse. We prescribed the patients pregabalin and then, through the case series, we saw how it managed their nightmare frequency, headache severity and how often they woke up feeling refreshed.”

The study, which was published in Nature and Science of Sleep, found that after roughly three months of treatment, monthly nightmares fell by 81%; and the number of nights per week that patients woke feeling rested more than doubled — an increase of 127%. Additionally, monthly headache days dropped by about 50%.

Some patients described pregabalin's impact in striking terms, calling it "life changing" and a "huge difference,” with several noting their nightmares returned when the medication was stopped and ceased again once restarted. Most patients tolerated the medication well, and 19 of the 23 chose to keep taking it.

A possible reason why pregabalin might help is because it decreases the amount of time a user spends in REM sleep, the stage in which most nightmares occur. Sedation is a common side effect when prescribed 2-3 times daily, but this study was among the first to test whether a simpler single nightly dose works, potentially reducing daytime sedation.

Bates credited Dr. Tobin for pushing him to probe further on the topic, citing his valuable mentorship and noting that he was a role model for what rigorous research looks like.

“Dr. Tobin is very detail-oriented,” Bates said. “Being intentional when reading papers is something that I’m trying to get better at by example through Dr. Tobin. He also taught me a lot in finding good journals to submit papers to.”

For Dr. Tobin, working with Bates eased the workload, and he credited Bates for pushing the project forward.

“Bates was the one who figured out what specific statistical tests were best for each outcome measure,” Dr. Tobin said. “He really drove the project. Especially the data extraction, which is time consuming and tedious, and I am grateful to him for undertaking that.”

While the case series yielded striking results, the authors cautioned that the findings are preliminary because it was a small study with patients taking other medications and without a comparison group.

Pregabalin is not FDA-approved for nightmares, and additional studies with more patients, some of whom receive pregabalin and some who do not, would lead to a clearer picture of pregabalin’s effect on nightmares, sleep quality and headaches. 

“In the long term, I would love to see a double-blinded, placebo-controlled clinical trial of pregabalin for patients with nightmares and who may or may not also have non-restorative sleep and headaches,” Dr. Tobin said. 

For Bates, the scale of the study’s results surprised him immensely and warrants more investigation.

“An 81% reduction is larger than most numbers I’ve seen for nightmare treatments,” Bates said. “I’m not going to claim pregabalin beats first-line therapies for nightmares without a head-to-head trial, but data this strong from a once-nightly medication is exactly why we need one.”