We use vagus nerve stimulation in two different forms, for two different problems. This page covers the non-invasive one — a handheld device held against the side of the neck for cluster headache and migraine, with no procedure and nothing placed. For painful diabetic neuropathy we use a temporary percutaneous system instead, which is a procedure.
What does the vagus nerve do?
The vagus is the tenth cranial nerve and the main parasympathetic pathway between the brainstem and the organs. It carries a large volume of sensory information upward, and it influences autonomic tone, inflammatory signaling and the brainstem circuits involved in some headache conditions.
That last point is why it matters in pain medicine. Several headache disorders — cluster headache in particular — involve brainstem and autonomic pathways the vagus reaches, which is why stimulating it can interrupt an attack.
What is vagus nerve stimulation used for?
- Cluster headache — used both to abort an attack in progress and to reduce how often attacks happen.
- Migraine — for acute treatment, and in some patients for prevention.
- Selected persistent head and face pain where autonomic features are prominent.
It sits alongside the targeted blocks we already use for headache — the sphenopalatine ganglion block and the occipital nerve block — rather than replacing them. For someone whose attacks are frequent, having something that works at home between visits changes the picture considerably.
Three things share this name — we do two of them
1. Non-invasive VNS — this page. A handheld device held against the side of the neck. Nothing is placed, there is no procedure, and you use it yourself. For cluster headache and migraine.
2. Temporary percutaneous stimulation — also offered. Fine electrodes placed under the skin at the auricular branch of the vagus nerve, the trigeminal branches and the upper cervical roots, worn about a month and then removed. For painful diabetic peripheral neuropathy. See that page — it is a procedure, unlike this one.
3. Implanted VNS — we do not do this. A surgically placed generator and lead, for epilepsy and treatment-resistant depression, placed by neurosurgery. Most of what is written online about “VNS” describes this one, so if that is what you came in expecting, none of the above is it.
How do you use a vagus nerve stimulation device?
- No procedure, no incision, no sedation and no recovery time.
- You are taught how to use it. The pattern differs between stopping an attack and preventing them, so the instructions matter more than the device.
- During use, a tingling or pulling sensation in the neck and a brief change in voice are both common. They stop when the device does.
- It is prescribed rather than bought, because it is not suitable for everyone — certain cardiac conditions, carotid disease and some implanted devices rule it out.
- It can usually be used alongside your existing headache medication, and is often used specifically to reduce how much acute medication you need.
Do vagus nerve stimulators really work?
Vagus nerve stimulation has generated real interest in inflammatory conditions and in widespread pain, and there is genuine science behind that interest. It is not, at present, established treatment for those indications.
We will tell you plainly which category your situation falls into. For cluster headache and migraine there is a body of evidence to point to. For fibromyalgia and inflammatory pain more broadly it remains investigational, and we would rather say so than let an expectation form.
What are the downsides of vagus nerve stimulation?
Non-invasive vagus nerve stimulation avoids the risks of an implant entirely — there is no surgical risk, no infection risk and no device to fail internally. The common effects are local and brief: tingling, skin irritation at the contact site, jaw or neck muscle twitching, and a temporary change in voice. Because it is not suitable with some cardiac and vascular conditions, your history is reviewed before it is prescribed.
To find out whether this applies to you, call or text us. We are at 12174 Natural Bridge Rd, Suite 110, St. Louis, MO 63044.
Common questions
Is anything implanted?
No. We use the non-invasive form — a handheld device against the neck. Implanted VNS is a different treatment, for epilepsy and treatment-resistant depression, and it is placed by neurosurgery.
For painful diabetic neuropathy we use a different, temporary system placed through the skin: Temporary Percutaneous Nerve Stimulation for Diabetic Neuropathy.
Will it cure my headaches?
No treatment for cluster headache or migraine is a cure. The realistic goals are aborting attacks faster and reducing how often they happen.
Can I use it with my current medication?
Usually yes, and it is often used precisely to reduce how much acute medication you need — which matters if medication overuse headache is part of the picture.
Chronic Headache and Migraine covers medication overuse headache and how we treat headache overall.
Is it suitable for fibromyalgia?
Not as established treatment. There is genuine research interest but it remains investigational, and we will say so rather than imply otherwise.
Fibromyalgia covers how we treat it.
Do I use it at home?
Yes. You are shown how, and the device stays with you — which is the main practical advantage over anything we can only do in the clinic.
Why have I not been offered this before?
Non-invasive vagus nerve stimulation is comparatively recent in headache practice and is not widely offered outside headache and pain specialty clinics.
Who should not use a vagus nerve stimulation device?
It is not suitable for everyone. Certain heart conditions, carotid artery disease and some implanted devices rule it out, which is why it is prescribed rather than bought. We review your medical history before prescribing it, then teach you how to use it, because the pattern for stopping an attack is different from the pattern for preventing attacks.
What does vagus nerve stimulation feel like?
Most people feel a tingling or pulling sensation in the side of the neck while the device is on, and a brief change in voice is common. Some notice skin irritation where the device touches, or twitching in the jaw or neck muscles. These effects are local and short-lived, and they stop when the device stops.
Sources
- Shao P et al. Role of Vagus Nerve Stimulation in the Treatment of Chronic Pain. Neuroimmunomodulation, 2023. PubMed 37369181
- Austelle CW et al. Vagus nerve stimulation (VNS): recent advances and future directions. Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 2024. PubMed 39363044
- Hilz MJ. Transcutaneous vagus nerve stimulation – A brief introduction and overview. Autonomic neuroscience : basic & clinical, 2022. PubMed 36201901
- Butt MF et al. The anatomical basis for transcutaneous auricular vagus nerve stimulation. Journal of anatomy, 2020. PubMed 31742681
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