Vivid Dreams and Nightmares as an Adverse Effect of Beta-Blockers in the Treatment of Episodic Migraine.
Carlos R Silva-Rosas, Heather Angus-Leppan, Alonso H Quijada, Andrés G Briceño
Case Reports in Neurological Medicine January 5, 2026 DOI: 10.1155/crnm/5581364 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Adult patients with episodic migraine with aura seen in the outpatient department of the Clinical Hospital of the University of Chile, Santiago, 2022-2024 |
| Interventions | Propranolol Metoprolol |
| Topics | Dreaming |
| Keywords | Propranolol Metoprolol Nightmares Beta-blockers Migraine prophylaxis Neuropsychiatric adverse effects |
| Key findings | Three patients with episodic migraine with aura developed distressing, recurrent nightmares shortly after starting propranolol or metoprolol, and the symptoms resolved when the drugs were stopped. The authors argue that lipophilic beta-blockers can cause vivid nightmares in migraine prevention, an effect they say is underrecognized, and recommend clinicians consider it when adherence or quality of life is affected. |
Abstract
Beta-adrenergic blockers are effective in migraine prevention but can induce neuropsychiatric side effects, including vivid dreams and nightmares. Their lipophilicity allows penetration of the central nervous system, where β1-adrenergic blockade may disrupt REM sleep, alter noradrenergic activity, and suppress melatonin secretion, contributing to emotionally intense dreams. While reported in cardiovascular patients, this adverse effect remains underrecognized in migraine therapy. Adult patients were identified from those seen in the outpatient department of the Clinical Hospital of University of Chile in Santiago between 2022 and 2024. We present three cases of patients with episodic migraine with aura who developed distressing, recurrent nightmares after initiating propranolol, or metoprolol. Symptoms emerged shortly after treatment initiation and resolved upon discontinuation. Nightmare content involved emotionally distressing themes, leading to significant psychological discomfort. Clinicians should be aware of vivid nightmares as a potential adverse effect of lipophilic beta-blockers in migraine prevention. Understanding this may enable patients to tolerate the symptom. If it impacts adherence and/or quality of life, a treatment change will be needed.
Comparable studies
Other case reports and case series on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lucid Dreaming as a Learnable Skill: A Case Study The author | 1980 | Case study | n = 1 |
| Lucid Dreaming as a Treatment for Recurrent Nightmares People with recurrent nightmares | 2010 | Case study | n = 5 |
| Treating Chronic Nightmares of Sexual Assault Survivors with an Intellectual Disability – Two Descriptive Case Studies Adults with learning disabilities suffering from post-traumatic nightmares | 2006 | Case study | n = 2 |
| Lucid dreaming: Correspondence between dreamed and actual events in one subject during rem sleep A lucid dreamer | 1984 | Case study | n = 1 |
| Lucid dreaming treatment for nightmares: A series of cases. Participants with nightmares | 2003 | Case series | n = 8 |
Citations in the library
Cites 3
- Nightmares in Migraine: A Focused Review Behavioral Sciences September 4, 2021
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. Journal of Clinical Sleep Medicine June 15, 2018
- Drug-induced nightmares. Annals of Pharmacotherapy 1999