Vagus nerve stimulation

A vagus nerve stimulator device is made up of a pulse generator and a coated wire with electrodes at the end. The pulse generator is about the size of a silver dollar (4 centimeters [cms] across and 1.0 to 1.3 cms thick). It is implanted on the left side of the chest below the left collarbone. The electrodes are connected to the left vagus nerve, which carries the electric signals to the brain.

You will be in a sleep-like state (general anesthesia) during the procedure.

During the procedure, the surgeon will:

• Make a small incision on the left side of your lower neck to expose your vagus nerve
• Make another small incision in the upper left side of your chest where the pulse generator is implanted
• Place the pulse generator device below your left clavicle between the skin and muscle
• Gently attach the electrode to your left vagus nerve and connect it to a pulse generator device
• Close the incision with stitches or staples

The surgery takes 45 to 90 minutes.

An external VNS device is also available. It is placed over the neck or earlobe and against the skin. This device is approved for preventing or treating cluster headaches and migraines. You use it by holding the device against the skin of the neck, which then blocks pain signals to prevent or relieve head pain.

VNS is used to treat a variety of conditions, including:

• Epilepsy. VNS is a treatment option for people age 4 years and older who don’t respond to anti-epileptic medicines and can't have brain surgery. VNS used along with medicines helps decrease the number, length, and severity of seizures. It also reduces the recovery time after a seizure.
• Treatment-resistant depression. VNS is used in adults 18 years and older who are not helped by other medical treatments for depression. VNS alters the levels of specific chemicals (called neurotransmitters) in the brain which help regulate mood.
• Rehabilitation after stroke. VNS helps to recover functions in the hands and arms after an ischemic stroke.
• Cluster headaches and migraine prevention. VNS helps prevent or treat these difficult-to-treat headaches.

VNS is not for everyone. You are not able to have VNS if you have:

• Breathing problems such as untreated sleep apnea, asthma, or chronic obstructive pulmonary disease (COPD)
• Active stomach ulcers
• Abnormal heart rhythms or low heart rate
• Previous surgery on your vagus nerve or have only one vagus nerve
• History of delusional or bipolar disorders
• Suicidal thoughts or behavior
• Abnormal functioning of the autonomic nervous system (controls unconscious body functions such as breathing and heart rate)

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Allergic reactions to medicines (anesthesia) used during surgery

Possible risks for this surgery are:

• Pain and soreness at the incision site
• Swelling or bruising near your incision area
• Damage to nearby nerve or surrounding structures in your chest or neck area
• Infection

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including drugs, medicines, supplements, or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day
• You have any bleeding problems or any previous surgery
• You have a history of schizophrenia, delusions, or bipolar disorder
• You have any heart abnormalities or breathing problems
• You have stomach ulcers
• You are allergic to anything
• You have ever received any brain stimulation

Planning for your surgery:

• If you have diabetes or other medical conditions, your surgeon may ask you to see the health care provider who treats you for these conditions.
• If you smoke, it’s important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help stopping smoking.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Ask your surgeon which medicines you should take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.

The day before your surgery:

• Let your surgeon know about any cold, flu, fever, herpes breakout, or other illnesses you might have.
• Shower and shampoo well. You may be asked to wash your whole body with a special soap.
• You may also be asked to take antibiotics to guard against infection.

On the day of the surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

After the surgery, you may stay overnight or go home on the same day. You will have two wound dressings, on your chest and on the left side of your neck.

You may have pain for a few days and feel a slight bump where the device was placed. Your provider may prescribe pain medicines. If you have been given antibiotics, take them as instructed.

Do not take baths, swim, or use a hot tub until your provider approves. You may be allowed to have sponge baths with your incision covered.

Avoid wearing tight clothes that could rub on your incision. Change your dressing as advised. Wash your hands with soap for at least 20 seconds before and after changing your dressings.

Check your incision for any signs of infection, such as redness, swelling, increased pain, warmness, or pus.

Your stitches will be absorbed on their own.

Ask your surgeon if you need to avoid driving or using any machinery.

You will have a follow-up visit to program the device in 2 to 4 weeks. The device is set to deliver stimulation at a certain frequency for a specific time at regular intervals. The device is usually set at low levels at first to see how your symptoms respond.

You will be given a handheld magnet to use at home:

• Sweeping the magnet over the device delivers extra stimulation.
• Removing the magnet makes the device resume the programmed stimulation cycle.
• This allows you to control the device as needed.

For example, if you have epilepsy, and a seizure is about to happen, you can swipe the magnet to send an extra burst of stimulation.

You will need regular checkups so your device can be monitored. Your provider will check:

• That the device is in the correct position and working properly
• The number of stimulations delivered
• If the programming needs to be adjusted
• How much power is left in the batteries

Check with your provider before having any imaging, such as an MRI, as it may interfere with the device.

Be sure to go to all of your follow-up visits as long as you have the device.

Side effects can occur due to nerve stimulation and are temporary. When you first start using VNS, you may notice:

• Hoarseness or a change in your voice
• Mild coughing
• A tickling sensation in your throat
• Shortness of breath
• Pain in your neck or throat
• Nausea, vomiting
• Difficulty swallowing or speaking
• Tingling or prickling sensation in the skin
• Headaches
• Difficulty sleeping or worsening of sleep apnea

These side effects usually improve with time.

VNS therapy can help improve the quality of life for people who receive it. However, it is not a cure, and it doesn't work for everyone. It can take a year or longer to know how well VNS will work.

Vagal nerve electrostimulation; Vagal nerve electrical modulation; Vagal nerve electric stimulation; Vagal nerve neuromodulation; Vagus nerve modulation

American Association of Neurosurgical Surgeons. Vagus nerve stimulation. www.aans.org/patients/conditions-treatments/vagus-nerve-stimulation/. Updated April 9, 2024. Accessed April 21, 2026.

Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 100.

Gross RE, Laxpati NG, McMahon JT. Electrical stimulation for epilepsy (VNS, DBS, and RNS). In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 100.

Luccarelli J, Henry ME, Fernandez-Robles C, Cusin C, Camprodon JA, Dougherty DD. Device neuromodulation and brain stimulation therapies. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 52.

Updated by: Evelyn O. Berman, MD, Assistant Professor of Neurology and Pediatrics at University of Rochester, Rochester, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.