1058 Triple Duty: Pregabalin for Chronic Headache, Insomnia, and Nightmares: A Case Series

Abstract Introduction Objective: To evaluate the effects of pregabalin on nightmare frequency, sleep quality, and headache frequency, severity, duration, and disability in patients with chronic headache, insomnia, and nightmares. Background: Headaches, insomnia, and nightmares frequently co-occur and contribute to substantial disability. While pregabalin has established roles in treating neuropathic pain, headaches, and anxiety, its potential benefit in reducing nightmares has not been systematically studied. Methods A retrospective case series was conducted, including 24 patients prescribed pregabalin for headache, insomnia, and nightmares. Clinical data were extracted from the medical record, including headache characteristics, sleep quality, nightmare frequency, and MIDAS scores. Within-subject pre–post comparisons were performed using paired t-tests or Wilcoxon signed-rank tests, depending on distribution. Results Pregabalin was associated with significant improvements across multiple domains. Nightmare frequency decreased by 81% (from 17.5 to 3.3 episodes/month, p = 0.001, large effect), and refreshing sleep nights increased by 127% (from 1.8 to 4.0 nights/week, p = 0.001). Headache frequency was reduced by 50% (from 17.0 to 8.5 per month, p = 0.010). Headache severity and duration decreased, but changes were not statistically significant, likely due to smaller sample sizes for these measures. Migraine-related disability scores decreased by 35% (from MIDAS 44 to 24.5, p = 0.020). Of seven patients with documented nightmare frequency who transitioned from gabapentin to pregabalin, six (85.7%) experienced substantial reductions, suggesting improved efficacy despite pharmacologic similarities. Conclusion Pregabalin demonstrated robust improvements in nightmare frequency, sleep quality, headache frequency, and migraine-related disability. The marked reduction in nightmares is a particularly novel finding, as pregabalin has not been previously established as a treatment for nightmares. These results suggest that pregabalin may offer a unique therapeutic option for patients with chronic headache, insomnia, and nightmares. Larger controlled studies are needed to confirm these findings and further elucidate underlying mechanisms. Support (if any)