gammaCore

Summary:
gammaCore is a handheld non-invasive vagus nerve stimulator (nVNS) used to treat and prevent migraine by applying mild electrical stimulation to the vagus nerve in the neck.

Biological Plausibility

Vagus nerve stimulation influences central pain processing, autonomic regulation, and neurotransmitter release. The vagus nerve has afferent projections to brainstem areas that modulate pain, including the nucleus tractus solitarius and locus coeruleus, both implicated in migraine.

Evidence

Multiple randomized controlled trials support the use of gammaCore for cluster headache, and several smaller studies support its use in migraine, including the PREMIUM II trial, which found clinically meaningful reductions in monthly migraine days compared to sham.

Effect Size

Patients using gammaCore preventively experienced a reduction of about 2–3 migraine days per month, with responder rates (≥50% reduction) between 30–40%. Acute use may shorten or abort attacks if applied early.

⚠️ Risk

Low risk. Some users experience mild skin irritation or neck muscle twitching during use. Serious adverse events are rare and no systemic effects have been reported.

Cost

$$$

Scores

  • Benefit: 4
  • Burden: 5
  • Ratio: 0.8

Clinical Takeaways

  • A viable non-drug alternative for migraine prevention and acute treatment.
  • May be especially useful for patients with medication intolerance or polypharmacy concerns.
  • Requires consistent daily use for prevention and early application during attacks for acute use.

Key References

  • Goadsby PJ, et al. *Non-invasive vagus nerve stimulation for the acute treatment of high-frequency and chronic migraine: an open-label study.* Cephalalgia. 2014.
  • Silberstein SD, et al. *Chronic migraine prevention with non–invasive vagus nerve stimulation: the EVENT study.* Neurology. 2016.
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