Is Nerve Pain a Rare Side Effect of Modafinil? Examining Clinical and Patient Evidence

Yes. Nerve pain appears to be a rare but real side effect of modafinil, documented in a published clinical case and reflected in specific patient accounts. It is not a common reaction and does not affect most users, but when it occurs, it can be severe and warrants prompt attention.

Most people take modafinil without nerve-related problems, experiencing only well-known effects such as headache, nausea, appetite suppression, or insomnia if they notice anything at all. Nerve pain is different. It is not listed as a routine adverse effect and appears only in uncommon, idiosyncratic cases.

A documented clinical case of neuropathic pain

The clearest evidence comes from a published medical case involving a young woman treated with modafinil for narcolepsy. After several weeks on the medication, she developed progressive pins-and-needles sensations, deep burning pain, muscle cramping, and weakness affecting her limbs. The symptoms worsened with continued exposure, reappeared when the drug was restarted, and resolved after discontinuation and supportive treatment.

Clinicians involved described the reaction as severe neuropathic pain closely linked to modafinil use, noting that such a presentation had not been widely reported before. While this represents a single patient, the timing, recurrence with re-exposure, and resolution after stopping the drug make the association difficult to dismiss.

How this differs from typical side effects

Common modafinil side effects are generally stimulant-like and predictable. Nerve pain falls into a different category. It represents an idiosyncratic reaction, occurring in a small subset of users without a clear dose-response pattern.

These reactions are uncommon, but they matter precisely because they are unexpected. When they occur, they are easy to misinterpret as anxiety, stress, or unrelated neurological symptoms.

Patient accounts describing nerve and sensory symptoms

In addition to the clinical case, individual patient accounts describe nerve-type symptoms emerging after starting modafinil or armodafinil.

One person taking 100 mg of modafinil for cognitive symptoms reported worsening tingling and itching sensations within the first week, while already using pregabalin. Another described burning, sunburn-like sensations on the face and scalp, pronounced sensitivity to touch in the hands, and later buzzing and jerking sensations in the forearm and hands, leading a neurologist to order repeat nerve conduction testing.

In these accounts, symptoms often intensified later in the day as the medication wore off and improved partially or fully after stopping the drug. The sensory quality of these symptoms aligns with neuropathic pain rather than simple overstimulation.

New nerve symptoms after starting modafinil

New onset tingling, burning, electrical sensations, or unexplained limb pain after starting modafinil should not be treated as routine adjustment effects. These symptoms differ meaningfully from restlessness or insomnia and may signal an uncommon adverse reaction.

In reported cases, symptoms improved after discontinuation. Continuing the medication despite progressive nerve symptoms can prolong discomfort and delay recovery.

What remains uncertain

There is no established mechanism explaining why modafinil triggers neuropathic pain in rare individuals. The drug affects dopamine, glutamate, orexin, and histamine pathways, but a direct link to peripheral nerve injury has not been shown. Whether these reactions reflect immune sensitivity, altered sensory processing, or another process remains unresolved.

What is clear is narrower: nerve pain is not a typical modafinil side effect, but it is a documented one.

Sources

• Saludes, A. M. A., Holfinger, S., & Sraha, G. (2025). An unexpected severe side effect following modafinil use. Sleep, 48(Supplement_1), A623–A624. https://doi.org/10.1093/sleep/zsaf090.1453
• Patient-reported experiences from r/LongCovid and r/idiopathichypersomnia describing tingling, burning, hypersensitivity, and neuropathic symptoms following modafinil or armodafinil use.