Transcutaneous vagus nerve stimulation
A new device (gammaCore) for treatment of cluster headache and migraine
In March 2016 the National Institute for Health and Care Excellence (NICE) published guidance on the use of a device called gammaCore in the treatment of cluster headache and migraine. The gammaCore device provides transcutaneous stimulation of the cervical branch of the vagus nerve.
What is transcutaneous vagus nerve stimulation?
The transcutaneous noninvasive vagus nerve stimulator (nVNS) (gammaCore©) device uses electrical current from a small handheld device to stimulate a nerve in the neck. The aim is to relieve pain and reduce the number of cluster headache or migraine attacks.
The person places the device, which is the size of a mobile phone, on the side of their neck. The level of stimulation is increased slowly until small muscle contractions are felt under the skin. The device is then held in position for about 90 seconds. It can be used to treat attacks, and between attacks to try to reduce the number of attacks.
Generally, studies showed the following benefits of using the device for migraine:
- pain relief in about half of patients, and complete pain relief in about 20% of patients, within 2 hours of using the device
- relief of sickness, sensitivity to light and noise in about 30–50% of patients
- recovery from disability caused by migraine in about 30% of patients within 2 hours of using the device
- other migraine treatment was needed in just over half of patients 2 hours after using the device.
The treatment should only be used if extra care is taken to explain the risks and extra steps are put in place to record and review what happens.
More research on this procedure is needed and NICE may look at it again if more evidence is published.