[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-444219-105":59,"doc-detail-444219-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","vivid-dreams-and-nightmares-as-an-adverse-effect-of-beta-blockers-in-the-treatment-of-episodic-migraine","Vivid Dreams and Nightmares as an Adverse Effect of Beta-Blockers in the Treatment of Episodic Migraine","","Beta-adrenergic blockers are effective in preventing episodic migraine but can cause neuropsychiatric adverse effects, including vivid dreams and nightmares. Lipophilicity may enable central nervous system penetration, where β1-adrenergic blockade can affect REM sleep, noradrenergic activity, and melatonin secretion, potentially producing emotionally intense dream experiences. Case identification from a Chilean outpatient cohort (2022–2024) found three migraine with aura patients developing distressing recurrent nightmares after starting propranolol or metoprolol, with symptom onset shortly after initiation and resolution after discontinuation. Clinician awareness is needed to support adherence and quality of life.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/vivid-dreams-and-nightmares-as-an-adverse-effect-of-beta-blockers-in-the-treatment-of-episodic-migraine/444219/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/vivid-dreams-and-nightmares-as-an-adverse-effect-of-beta-blockers-in-the-treatment-of-episodic-migraine/444219.png","ImageObject",300,407,{"name":92,"@type":93},"Cipher","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why can beta-blockers cause vivid dreams and nightmares in migraine prevention?","Question",{"text":112,"@type":113},"Their lipophilicity may allow central nervous system penetration, where β1-adrenergic blockade can disrupt REM sleep, alter noradrenergic activity, and suppress melatonin secretion, contributing to emotionally intense dreams.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What treatment changes were associated with improvement in the reported nightmares?",{"text":117,"@type":113},"In the presented cases, discontinuation of propranolol (and related management adjustments) led to immediate resolution of nightmares.",{"name":119,"@type":110,"acceptedAnswer":120},"How soon did symptoms appear after starting beta-blocker therapy?",{"text":121,"@type":113},"Symptoms emerged shortly after treatment initiation and resolved upon discontinuation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},444219,1790813694,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Wiley  \nCase Reports in Neurological Medicine Volume 2026, Article ID 5581364, 6 pages [https://doi.org/10.1155/crnm/5581364](https://doi.org/10.1155/crnm/5581364)  \nCase Report  \nVivid Dreams and Nightmares as an Adverse Effect of BetaBlockers in the Treatment of Episodic Migraine  \nCarlos R. Silva-Rosas , 1 Heather Angus-Leppan ,2,3 Alonso H. Quijada , 1  \nand Andrs G. Briceño 1  \n1 Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Santiago de Chile, Chile  \n2 Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK  \n3 Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK  \nCorrespondence should be addressed to Carlos R. Silva-Rosas; [csilros@uchile.cl](csilros@uchile.cl)  \nReceived 4 May 2025; Revised 3 December 2025; Accepted 6 December 2025  \nAcademic Editor: Semonti Nandi  \nCopyright © 2026 Carlos R. Silva-Rosas et al. Case Reports in Neurological Medicine published by John Wiley & Sons Ltd. Tis isan open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nBeta-adrenergic blockers are efective in migraine prevention but can induce neuropsychiatric side efects, including vivid dreams and nightmares. Teir 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 efect remains underrecognized in migraine therapy. Adult patients were identifed 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 signifcant psychological discomfort. Clinicians should be aware of vivid nightmares as a potential adverse efect 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.  \nKeywords: beta-blockers; metoprolol; migraine prophylaxis; neuropsychiatric adverse efects; nightmares; propranolol  \n1. Introduction  \nTe optimal selection of preventive treatment for migraine is individualized, requiring multiple considerations in deciding on specifc medications and nonpharmacologic approaches [1–6] . Currently, calcitonin gene-related peptide (CGRP)–targeting therapies are recommended as a frst-line approach for migraine prevention, alongside traditional frst-line treatments, without the necessity of prior failure of other migraine preventive treatments [1, 2] . However, economic factors signifcantly infuence clinical decisionmaking in migraine management [1–3] .  \nTraditional preventive migraine treatments were initially developed for other medical conditions before being adopted for migraine [1–5] . While clinical evidence supports  \ntheir efcacy, these treatments are associated with concerns regarding tolerability, safety, and the absence of clear predictors for treatment response [1] . Nonspecifc migraine treatments continue to be widely used in many countries [4–6] .  \nBeta-adrenergic blocking drugs are an established treatment option with proven efcacy for episodic migraine, with and without aura [1–6] . Tese medications are longstanding, widely available, and cost-efective [3, 6] . Teir exact mechanisms of action in migraine prophylaxis remain unclear [4], and they are associated with neuropsychiatric adverse efects, including depression, fatigue, insomnia, drowsines","cbCaifoYuSdjP1fT","https://ap.wps.com/l/cbCaifoYuSdjP1fT","pdf",438677,"English","# Introduction\n## Preventive migraine treatment overview\n## Neuropsychiatric adverse effects of beta-blockers","[{\"question\":\"Why can beta-blockers cause vivid dreams and nightmares in migraine prevention?\",\"answer\":\"Their lipophilicity may allow central nervous system penetration, where β1-adrenergic blockade can disrupt REM sleep, alter noradrenergic activity, and suppress melatonin secretion, contributing to emotionally intense dreams.\"},{\"question\":\"What treatment changes were associated with improvement in the reported nightmares?\",\"answer\":\"In the presented cases, discontinuation of propranolol (and related management adjustments) led to immediate resolution of nightmares.\"},{\"question\":\"How soon did symptoms appear after starting beta-blocker therapy?\",\"answer\":\"Symptoms emerged shortly after treatment initiation and resolved upon discontinuation.\"}]","Vivid Dreams and Nightmares as an Adverse Effect of Beta-Blockers in the Treatment of Episodic Migraine | PDF",1790707252,15]