Noninvasive (nVNS)—using a handheld device that delivers a mild electrical current through the skin of the neck in two-minute applications that stimulate the —was approved for the treatment of migraine headaches by the Food and Drug Administration (FDA) in January 2018.

Source: Courtesy of electroCore

At the time, Stephen Silberston, the director of the Headache Center at Thomas Jefferson University, said in a statement, "With the FDA’s decision to release gammaCore [noninvasive vagus nerve stimulation] for migraine, patients now have access to an effective and safe which can be self-administered to acutely treat the pain associated with migraine."

Multiple studies have shown that nVNS provides significantly more pain relief for migraine and cluster headache patients in comparison to a sham device. In 2017, gammaCore was approved by the FDA for the treatment of cluster headaches.

This afternoon, researchers announced for the first time that noninvasive vagus nerve stimulation may also help another specific type of migraine, associated with dizziness and vertigo, called "vestibular migraine." Currently, there are no approved treatments for the head-spinning disorientation and vertigo associated with this condition.

These findings were published online September 25 ahead of print in the journal Neurology. This study (Beh & Friedman, 2019) provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache pain in patients with acute vestibular migraine.

For this study, each participant received electrical stimulation via a handheld gammaCore device placed against each side of the neck for two minutes during a vestibular migraine attack. Some patients reported a mild tugging sensation in their neck muscles during the nVNS treatment but did not report any other adverse side effects.

"There's a huge need for effective treatments for vestibular migraine attacks," co-author Shin Beh of the University of Texas Southwestern Medical Center in Dallas said in a news release. "People with vestibular migraine do not always have headaches and when they do, they are often less severe than in typical migraine, so the pain-relieving drugs used for typical migraine often are not effective. People can take drugs that suppress the vertigo or the nausea, but those drugs cause drowsiness and make it hard for people to go about their usual activities."

In a recent interview with Judy George of MedPage Today, Beh said, "[Our study] suggests that the vagal circuitry is interconnected with the vestibular system, and these connections may explain how nVNS alleviates vertigo in vestibular migraine attacks."

This study has some noteworthy limitations such as small size, lack of a control group, and the absence of sham experiments.

Also, all of the vestibular migraine patients in this study knew they were receiving noninvasive vagus nerve stimulation, which could generate a . Because of this, the researchers emphasize that a larger, randomized, double-blind study in which some patients also receive sham stimulation is needed.

"Vestibular migraine is the most common neurologic cause of vertigo, and can greatly interfere with a person's daily life," Beh said in a statement. "If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use."

The authors sum up their findings in the paper's conclusion: "Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute vestibular migraine, and supports further randomized, sham-controlled studies into nVNS in vestibular migraine."

Note: To the best of my knowledge, gammaCore is currently the only handheld nVNS device on the market. For the record, I do not endorse this product, nor do I have any conflict of interest or affiliation with electroCore, who manufactures the device.

DISCLAIMER: Please use common sense and do not rely on information in this blog post as an alternative to seeking medical advice from your primary care physician or professional healthcare provider. If you have specific questions about treating vestibular migraine attacks using noninvasive vagus nerve stimulation, please consult with your doctor or a specialist.