How does the gammaCore work?

gammaCore is an external vagus nerve stimulator that is FDA-approved for treating cluster headache and migraine. To explain what makes the gammaCore work, I have to back up a bit to talk about the vagus nerve.

What is the vagus nerve?

image of the vagus nerve

The vagus nerve is the body’s longest cranial nerve and has many branches. It connects to numerous organs, including the heart, lungs, and stomach. (The vagus nerve is shown in yellow in the image.) Here’s how electroCore, the company that makes gammaCore, describes the vagus nerve:

It is the longest cranial nerve in the body, primarily serving as a sensory nerve, bringing information from the visceral organs to the brain. The vagus nerve has a number of branching nerves that go to the heart, lungs, voice box, stomach, ears, and other organs. As a sensory nerve that assesses the condition of these organs, it is the communication between the brain and the body. It contains motor and sensory fibers and, because it passes through the neck and thorax to the abdomen, has the widest distribution in the body.

While we don’t hear as much about the vagus nerve as we do the occipital or trigeminal nerves, researchers believe it plays an important role in both migraine and cluster headache. You’ve likely heard of the vagus nerve in connection with it’s most “famous” responsibilities: it plays a central role in the fight-or-flight response and it connects the brain to the stomach, sending signals between the two. (Since eating anything is a migraine trigger for me, this connection is what prompted me to travel to Canada to try the gammaCore.)

How does the gammaCore work?

Like with so many therapies, how the gammaCore works isn’t entirely known. electroCore’s website currently says, “Stimulating the vagus nerve affects many important autonomic functions in the brain and in the body, including neurotransmitter levels, inflammation levels, and metabolism.” In videos published in 2012 and 2014, electroCore explains the role of neurotransmitters and how the gammaCore influences them. Here’s my summary (and you can watch the videos yourself below).

The gammaCore is thought to balance neurotransmitters, which help regulate a person’s nervous system. Neurotransmitters can be classified as excitatory or inhibitory. Excitatory neurotransmitters rev up the nervous system; inhibitory neurotransmitters calm the nervous system. The brain tries to maintain an equilibrium by constantly balancing excitatory and inhibitory neurotransmitters. Scientists believe that people with headache disorders like migraine and cluster headache may have too many excitatory neurotransmitters and not enough inhibitory neurotransmitters. One particular neurotransmitter, glutamate, is particularly suspect. The gammaCore is thought to balance neurotransmitters by stimulating the “nervous system’s superhighway,” as electroCore calls the vagus nerve.

Video Explanations of How the gammaCore Works

These videos from electroCore, the company that makes the gammaCore, give a better explanation than I can. The information in the two videos is basically the same—the first is the layperson’s explanation and the second is more technical. Both videos are worth watching, though I recommend starting with the intro video. (You may be annoyed by the narrators’ liberal use of the word “headache”—it can seem like they minimize the severity of migraine and cluster headache. I give them leeway because they’re trying to encompass both migraine and

28 thoughts on “How does the gammaCore work?”

  1. Candy, I have had the same problem for 18 months. It resulted in me cutting back on ordering it. The coordination of Gammacore staff (east coast) and Premier staff (west coast ) is problematic and is complicated by the time difference in business hours. I spoke with the East Coast senior sales rep, Julie Collins ( Julie.Collins –met her at my headache clinic) and all she could do was give me a dedicated contact at Gammacore. She has no influence with Premier. The device is effective but expensive. Even with their coupon it’s $350. The logistics of obtaining it is headache inducing.

  2. I’ve used gammacore for about a year and a half and it is definitely helpful, but their customer service is terrible. Premier Pharmacy is the contract pharmacy. I’ve had a really hard time with them, and it’s just getting worse: late arrivals of pre-paid refill cards, múltiple days and phone calls required to resolve defective device, likewise several days runaround to get them to replace defective refill card – and more. I cannot seem to find anyone or anywhere, any point of pressure to induce a decent response.

    Any suggestions or ideas appreciated.

  3. Thanks for the encouraging story. I’ll keep trying the Gammacore, and hope my persistence pays off! It sounds like your chronic migraines are now well under control. Do you attribute that to the Gammacore or to something else? I’d love to know what ended up working so well for you!

  4. Hello,
    Can you please describe the sensation of using the device? Does it feel like an electric shock? Thanks so much.

  5. Does this work for chronic daily headaches and chronic hemicrania continua? I have different types of headaches and migraines that are usually one sided stabbing and then spreading to face. I often get allodynia after a bad migraine attack which usually subsides in 3-4 days but I always have creepy crawly feeling in the right head and face. When I have a stabbing migraine I take Reloax and it’s hit or miss. I’ve tried 2 CGRPs without success and awful
    Side effects. I’m willing to try something else but cost is a factor.

    1. Hi Mel, I’m not sure if it will work for CDH or hemicrania continua. I’d see what your doctor has to say. Since you also have migraine, it might be worth a try.

      Take care,

  6. I recently received the Gammacore Sapphire (for free for a year!) but it doesn’t seem to help my migraines. I’ve tried it about ten times at different intensities (varying from 20 to 30). Do you think it’s more effective at higher intensity levels? I get the muscle contraction they discuss in the instructions at about level 25. I’d love for it to work for me! Any advice from you or other users would be much appreciated.

    1. Hi Monique,

      For the first couple months, I had to use it on the highest level. Even then, I didn’t get any noticeable relief for the first month or so. I kept with it because I was convinced it could help me. I’m glad I did! I used it for 2.5 years and then stopped using it because I no longer needed it!

      Take care,

  7. Hi I found this type of stimulation on the vegus nerve very helpful with my daughter who has severe anxiety and “adhd” she is totally different and way happier. she says she feels way better. i like this solution way better than drugs for her and my quality of life for everyone in my family goes wayyyyyyyyyyyyy up when we are in coherence.

    how can i get this device if i am not using it for cluster headaches? the place i was getting the treatments recently closed. I don’t care how much I have to pay for it, money isn’t my problem, my poor daugther’s and mine anxiety is.

    1. Hi Age, you can contact gammaCore’s customer service to see if it’s available off-label. Then you’d need to find a health care provider (doctor, physician assistant, nurse practitioner, or naturopath) to prescribe it for you.

      Take care,

  8. I got my gammacore 5 days ago. I have had 15+ migraines per month for the past 18 years. I am no longer taking triptans. Since I received my gammacore, I have not had to suffer a migraine. Each time I feel that first hint of pain, I use the gammacore. If this is the answer to my nightmare, it will be well worth the money. Also it is my understanding that this is not an electrical stimulation but a sound wave, but I don’t know for sure.

  9. Has anyone that’s torn this apart have anything to report? I’m wondering if it be possible to approximate the vagus nerve treatment with a TENS unit?

  10. Help!! The GammaCore seemed to work for me for migraine. However, I cannot afford $600/month. How can I get my insurance to pay?

  11. Hello!

    I figure the best way to go about this is to just say it…

    I’m rather desperate to be involved in a community of similarly-plagued individuals as I’ve realized I can’t do this on my own. I’ve struggled so hard to find any resource or community that is providing information that has been helpful in me overcoming my chronic migraines. In all my years of researching migraines, I’ve found myself here on this site time and time again and I think it makes sense to just stop wavering outside of the door and just enter!

    I realize this is not the ideal blog post to make my introduction but I wanted to go with the most recent. I wasn’t sure where else on the site to nudge myself into. I’m of course open to advice but this isn’t all about me, it’s about all of us suffering and any knowledge we can share amongst ourselves is likely beneficial to the other. In the interest of sharing my ongoing story.

    A bit about me.. I’m a 29 year old male and I’ve had migraines since I was 6. I was born with very serious allergies (mainly to foods). The earliest recollection of my first migraine was around 9 or so when I started to lose vision (blind spots) in my upper left field of vision. These dots would spread more and more until I was about half blind. I would get quite nauseous and dizzy and weak and after about a half hour, my vision would return and I would feel relatively fine until the pain would creep in. I would then get excruciating pain (tantrums of tears and such) lasting hours until I inevitably passed out from exhaustion. When I was younger, I took Excedrin and it would help me get to sleep. I would be hungover for a few days after but I would recover. I got these migraines a few times a month. Around the age of 27, my migraines changed entirely. I still from time to time (every few months or so) get a migraine exactly like I described above though the pain is far more tolerable (I don’t even take medication anymore for it). Now I get what I would best describe as Basilar Migraines about once a week.

    My symptoms consist of all kinds of things (my girlfriend says it’s like the migraine reaches into a hat and picks the recipe of disaster for the day). I haven’t been able to pinpoint any pattern so I’ll just share all of them and mention which other symptoms they pair to. These migraines do not have any blindness associated with them but visual auras are present.

    Auras – Sometimes days before my migraine or days after, it’s impossible for me to nail down, I start seeing essentially rainbow colored static everywhere. My eyes are in perfect health so my docs know it is neurological. They only come when I’ve done something to upset my migraine threshold. I see colors everywhere in a very faint fashion, I can’t describe the colors in specifics as I can’t focus on them, they are just rather transparent, flittering, moving, flashing all over. It is so subtle in fact that I’ve learned to ignore them that I rarely realize it is there sometimes. I just focus on the colors that are sharp and definite and not on the ones that are hard to focus on. They are not lines (I’ve had those) or shining blips of light that pass to and from from vision (I’ve had those) or the effect of objects dripping as if they were made of liquid (I’ve had that before). This is more like just a collection of multi-color dot grain film over everything I see. It is such a pain. From there, it often turns into double vision and which I see a copy of everything backdrops and slightly offset to the upper side of what I am looking at it. Again it very subtle and I often only notice it with text. It is as if I’m seeing a ghost copy of everything beside the actual thing. What is quite interesting is I can summon this symptom at anytime I wish or anytime I talk about it as it is nearly there all the time and most of the time I just try to ignore it. I don’t have any emotional stress talking about it nor thinking about it and I don’t seem to have any physically elevated stress responses in talking about it or thinking about it and yet I can summon it as if it is some mentally-concocted phantom illlness. I digress, moving on…

    Higher sensitivity to sound. Things don’t seem louder but certain noises make my brain instinctively twitch inside my head in a very uncomfortable and alarming fashion. I’ve naturally developed very serious anxiety due to this though since these attacks began, I’ve gained mastery over my anxiety through some really good therapists and my general good outlook on life despite what plagues me. While emotionally my anxiety is fine, my body during these attacks is on this weird high-alert and certain sounds trigger that snapping feeling deep in my head that makes me fainty sometimes. This symptom comes and goes whether the attack is in full force or not.

    Ringing in my ears appears frequently but mainly during the attack.

    Motor function impairment: I struggle to walk as if my muscles suddenly deteriorated into someone who hasn’t walked for days. I lose my ability to balance and have to walk very slowly, carefully, and flat-footed to wherever I’m going and often don’t want to go anywhere. This only happens during the attack and lasts about 1-3 hours. In very rare attacks, I’ve lost the ability to move entirely or one side of the body is fine and the other is suffering the effect I’ve described above. This only appears to affect my legs and arms and rarely finds its way to my face though I’ve mimicked stroke symptoms enough to go to the hospital a few times though I haven’t experienced the one-sided madness in at least a year and haven’t experience it in my face in more than two years.

    In some attacks, not very common but not rare, I struggle to speak effectively. I have a hard time finding, pronouncing words or keeping my train of thought and have to really slow myself down and concentrate to get out a sentence. My breathing is not short (in most cases), it is just my ability to communicate. In rare cases, I can’t speak altogether as it is just so much effort to figure out how to make the sounds of the word and move my lips at the time as activating the vocal chords. I usually just revert to hand signals and grunts. It isn’t always severe, sometimes I just sound like a drunk person slurring their words together, my gf often teases me when I’m like this to help me handle the horrifying anxiety of it. It’s truly miraculous how far we’ve come in reversing the demonizing of this particular symptom though we of course always check for stroke.

    Confusion/Inability to concentrate in high-stress environment plagues me the most. I am a highly intelligent person and can normally accomplish very great things at the workplace. When this symptom comes a knocking though, I undo all my greatness in a very short time period. Employers are not very forgiving when profits take hits so I’ve had to not work altogether to avoid damaging my status and position at my company. I now have attendance issues with them though they have tolerated my migraines for years they are just starting to get impatient as they feel I’m not making enough effort to fix them. Getting back on track of describing the symptom itself. I do the classic thing of swapping words in a sentence or numbers or forgetting everything I just said seconds after saying it and losing myself in the middle of a conversation and making the person have to repeat themselves. Things like that. Sometimes I can weeks without this symptoms and sometimes the symptom lasts weeks. When it lasts long periods of times, I start to develop depression and self-confidence issues though once it ends, I’m back to normal as if nothing happened.

    Boding tingling is strong during an attack. I feel like my body is made of thousands of metallic beads moving to and fro as I move. It’s a kind of numbing feeling and extremely uncomfortable. It often subsides after a few hours.

    Losing consciousness: I’ve only blacked out once from an attack and thankfully I was at the hospital already. Very often though during attacks, I feel very fainty and struggle to stay conscious. I’m often too terrified to go to sleep because I think I won’t wake up so I stay conscious long enough (at least an hour) until most of my symptoms start to lessen and once I feel normal and comfortable enough, I succumb to the feeling and go to sleep for a few hours.

    Pain: The pain is random is often not there. When it is, it isn’t very severe and a quarter cup of coffee or a soda gets me through the day. I don’t touch caffeine in any cases other than during severe pain attacks and even then only when I have them at work and can’t leave because I can’t drive.. The caffeine intake is very low and I get no withdrawal symptoms in the days after.

    There are so many more symptoms but I’d like to move on in the interest of not writing a book to you all though this is already uncomfortably long.

    Prevention! I’ve tried various medications and all have made me infinitely worse to the point that I’ve gone off all of them. I’ve eliminated alcohol entirely from my diet, I only drink water and 10 bottles a day on average. I sleep 7 hours a night during the week and about 8-9 on the weekends. I eat every 3 hours usually and eat until I can’t eat anymore (I’m always not hitting my calorie mark despite eating what I feel is a fair amount). I only drink caffeine as I’ve mentioned during severe pain attacks which happen about once a month and drink a very small amount. I don’t touch it otherwise. I’ve recently as of the beginning of 2018 removed all gluten from my diet. For a span of 3 months all I ate (for the most part as directed by my neurologist) was a granola bar in the morning with a 3-egg omelette served with spinach (or steel-cut oatmeal), a yogurt after, chicken or salmon at lunch usually with extra-long grain brown rice with steamed broccoli or steamed carrots or spinach. Dinner being either chicken, salmon, or steak served with potatoes (baked or sweet) and either corn/broccoli/carrots/rice/spinach as a side to either. I felt relatively healthy during the last 3 months but my migraines stayed at about once a week and in at least a few weeks (twice per week). This new diet (stated above) that I begin in 2018 caused a host of illnesses to me that lasted the entire month of January that consisted of flu-like symptoms and gastrointestinal issues like bile coming up my throat often. My Gastroenterologist or however you spell it wanted me to to go my low fodmap and suspected allergies and/or food tolerances at play. Many of the things mentioned in the diet were rather new to me and so my allergies became a concern again. I’ve yet to get my food allergies tested and we’ll see how that goes (should be soon). The gas issues have been so bad they put me on omeprazole (had to go to ER twice for the severe pain all over my frontal chest and abdomen area). After the omeprazole ended about a week ago, the symptoms returned and while I await tests to be done, I started an elimination diet of just chicken and brown rice. It solved all of my gas/flu issues immediately and hopefully indefinitely so that is awesome! Unfortunately, migraines are still at play once a week and are unchanged though it has only been a week and half so waiting to see where this goes. I’m on a multi-vitamin until I see a dietician who hopefully can help me figure out what supplements to take in the meantime and to help me work through this diet. It is excruciating to tolerate eating only this and I expect to pepper minor things in here and there in small doses to see how it makes me feel. I have a host of food allergies that seem linked to pollen which removes so many options for me in the fruits and vegetables section of healthiness… As for stress, I am a very optimistic person despite how this may read and unbelievably strong-willed. My workplace is difficult and I would get another job if I could but nobody will hire me because of my attendance issues (I have tried probably over 50 times to closer work places – I have to commute 2 hours to my currently job just to make 12 and hour 5 days a week (more like 4 thanks to migraines). I’ve been incredibly poor for years because of all the hospital visits, hiatuses from work during severe (stroke-like) attacks and yet somehow stronger and happier than I’ve been in a long time. I’m just at the point where I know I’m not solving this well enough alone and want to take the next step of communicating with other people just like me suffering through these odd neurological symptoms of migraine. I hope anybody who takes to reading this doesn’t judge me too harshly for writing a book! Perhaps I’ll make a blog of my own if not just to document all the things that happen to me though it is incredibly hard to be so disciplined with this disorder if you will.

    You’ll see me around and please don’t hesitate to share your stories with me however you wish, I want to help us help each other just like the wonderful owner of this blog 🙂

    <3 Tom
    (forgive my typos, I'm not proof-reading this :P)

  12. Hi Kerrie can you please explain what the Gammacore charger is? And the replacement after first purchase ?
    Thankyou Kindly

    1. Hi Denice, there is no charger. They replace the device every month. They’re working on a rechargeable device that they plan to release this summer.

      Take care,

  13. Do you have to return the unit when it runs out of treatments? I am electronics engineer, and have had headaches all my life, tried every pill and treatment except Botox , only thing that works is 4 to 6 Excedren a day. I have found that actually pushing on the vagus nerve does give me relief when I have a real pounder. Having never seen one of these devices I can can only speculate that it is some kind of oscallator u-proccesor controlled and the signal sent to some accoustical or electrol stimmulator contacts. They must have an event timer, then shuts the unit down after so many uses. It would be nice to get a look at one and see how it ticks.

    1. Hi Tom, you don’t have to return them. You’re supposed to dispose of them with hazardous waste. I have a friend who teaches engineering who has similar speculation, but she hasn’t had a chance to take it apart yet. The company is about to release a rechargeable device that’s updated with a new sim card every month. If you want to get your hands on one of the current ones, I recommend doing it soon!

      Take care,

  14. Hi Kerrie, thanks for all of this information! Can you write a post about how effective the gammaCore has been for you? Are you on a restricted diet at all at this point (avoiding aged food, etc.)? Does it help both migraines and CDH? Do you use it preventatively (with each of your meals) or do you use it to treat an acute migraine attack? Thanks!

    1. Hi Marie, I definitely will. To answer your questions briefly:
      –My diet is basically unrestricted. I’m careful about what I eat, especially when I have plans and don’t want to risk a migraine attack. The gammaCore is fiddly–I have to get it at exactly the right level or it won’t work fully. I’m working on a post about that. I’ve had stronger-than-average reactions to Thai and Indian food, so I haven’t eaten much of those yet.
      –My background headache is a 2-3 most of the time, which is definitely an improvement.
      –I use it acutely. I tried it preventively, which triggered migraine attacks.

      Thanks for the great questions. More soon!

      Take care,

  15. Gamma Core sounds like it might be worth trying. I have 15 or more migraines a month. Where is the gamma core available?

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