Recent Evidence in Vagus Nerve Stimulation in Migraine and Trigeminal Autonomic Cephalalgias

A Renewed Look at NeuromodulationVagus nerve stimulation (VNS) has evolved over the past decade from a niche experimental therapy into a promising adjunct for headache medicine. Two new publications in Cephalalgia—the official journal of the International Headache Society—offer valuable updates on both clinical outcomes and mechanistic understanding of how this therapy may benefit people living with migraine and trigeminal autonomic cephalalgias (TACs).

Real-World Outcomes: Long-Term Safety and Clinical Insights

Fernandes and colleagues (2025) presented an 11-year, single-center experience using non-invasive vagus nerve stimulation (nVNS) in a range of TACs, including cluster headache, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks (SUNCT and SUNA).

Their findings demonstrated that:

• nVNS was safe and well tolerated over long-term use.

• It appeared to be more effective for prevention than for acute rescue.

• Patients who adopted nVNS as part of a broader, integrated care plan often reported improved quality of life.

While these results are encouraging, the authors noted that their data were observational. Larger randomized controlled trials remain essential to determine consistent efficacy and refine treatment parameters.

Mechanistic Insight: How VNS May Interrupt Migraine Pathways

Liu and colleagues (2024) examined how VNS affects cortical spreading depression (CSD)—the electrical wave believed to initiate migraine aura and subsequent pain signaling. In a preclinical animal model, they found that VNS:

• Inhibited CSD propagation in a dose-dependent manner.

• Activated the nucleus tractus solitarius (NTS) in the brainstem, which then influenced the locus coeruleus and dorsal raphe nucleus, key centers for pain and autonomic modulation.

• Reduced neuroinflammatory signaling and altered tropomyosin receptor kinase B (TrkB) activity, offering a mechanistic explanation for its preventive potential.

Together, these findings suggest that VNS may act upstream in the migraine cascade—stabilizing the neural and autonomic circuits that precede headache onset.

Clinical Integration: Where VNS Fits in 2025

Based on recent evidence, non-invasive VNS may:

• Provide a preventive option for cluster headache and related TACs.

• Serve as a non-pharmacologic adjunct for migraine prevention.

• Fit naturally into a holistic autonomic regulation framework that includes lifestyle optimization, mindfulness, and breathwork.

At the same time, clinicians and patients should remain objective: controlled data are still limited, device costs vary, and individual responses can differ significantly.

Prime Day Perspective

It happens to be Amazon Prime Day, and several vendors are offering short-term discounts on VNS and transcutaneous VNS (tVNS) devices.

This post is not sponsored by, nor does it endorse, any specific product or company.

Consumers considering these devices should:

1. Research device types and clinical data (cervical versus auricular models).

2. Compare safety, intensity settings, and warranty information.

3. Consult a licensed healthcare provider before purchase or use.

A Personal Reflection

In my own experience, vagus nerve stimulation, combined with meditation and breath work, has been transformative in managing headache, migraine, facial pain, and related autonomic disorders. These modalities work synergistically—enhancing parasympathetic tone, improving recovery, and restoring a sense of agency in health and healing.

While not a cure, VNS can be a meaningful tool in a comprehensive self-care and clinical framework—embodying the spirit of Honor. Homeostasis. Hope.

References

Fernandes, R., et al. (2025). Neuromodulation in trigeminal autonomic cephalalgias: 11-year experience of non-invasive vagus nerve stimulation. Cephalalgia.

Liu, X., et al. (2024). Vagus nerve stimulation inhibits cortical spreading depression. Cephalalgia.