Note: tVNS for Long Covid is currently only an experimental/theoretical treatment. Talk to your doctor before trying this. Remember, this page is NOT medical advice. It is for information purposes only.

The vagus nerve is the one of the longest nerves in the body and is vital to regulating many unconscious functions of the body such as blood pressure, heart rate, digestion and sweating. It is part of the autonomic nervous system and it controls our sympathetic (fight and flight) and parasympathetic (rest and digest) responses. The vagus nerve has two parts, left and right, which run from the brain down each side of the head and throat. For more info on the vagus nerve and the autonomic nervous system, please see the HRV page.

Several studies have found that some people with Long Covid have dysautonomia (Barizien, 2021; Marques, 2022) and show vagus nerve dysfunction (Acanfora, 2022) or atrophy (Papadopoulou, 2022). Long Covid patients may have increased sympathetic activation which indicates ongoing stress in the body. This leads to a cascade of symptoms including insomnia, constipation, issues with blood pressure and heart rate, among others. A possible treatment option for this is improving “vagal tone” – prompting the autonomic nervous system to switch towards parasympathetic response more often, in the hope of attaining a more balanced system. You’ll find some ideas for this on the HRV page.

A possible, experimental way to improve vagal tone is with transcutaneous vagal nerve stimulation (tVNS). This involves stimulating the vagus nerve with electrical signals via the neck or ear. This can be done with specialised devices or with a transcutaneous electrical nerve stimulation (TENS) machine. In theory, stimulating the vagus nerve with electricity can modulate the autonomic nervous system. Typically the left nerve is stimulated.

At time of writing, tVNS for Long Covid is very much an experimental treatment. While tVNS has been clinically used to treat epilepsy, heart problems and depression (Lampros, 2021), there’s not a lot of evidence to suggest it will work for Long Covid. A pilot study currently in preprint found that “taVNS may have a mild to moderate effect in reducing mental fatigue symptoms in a subset of individuals” with Long Covid and suggested further research (Badran, 2022). The study found tVNS was safe to use on people with Long Covid. A 2021 study of tVNS on 20 people with Long Covid found that “all the patients improved dramatically during treatment.” (Verbanck, 2022). Note that the latter study was done in partnership with Parasym.

People with ME/CFS have been experimenting with tVNS over the last few years. Leading this DIY research is occupational therapist Andrea Parker, who had severe ME/CFS and made a partial recovery through self-experimentation with tVNS. She has been working with Dawn Wiley, who runs a tVNS Facebook group called A Vagus Adventure AVA and Dr Nicola Clague-Baker from the University of Liverpool, who runs Physios for ME. In 2022 they released the results of a survey of 116 people with ME/CFS who had tried tVNS. A little over half said they found using tVNS to be beneficial in some way. A 2021 study of 37 people with ME/CFS, fibromyalgia and rheumatoid arthritis found that tVNS helped reduce daytime sleepiness and depression.

Almost all of the information below is based on Andrea Parker’s recommendations. Health Rising has a good summary of her work here.

Again, this is all experimental and Ms Parker is keen to point out that she is not a doctor. She recommends discussing all this with a doctor before trying tVNS.

Here’s Andrea giving a brief overview of the theory behind tVNS for ME/CFS

In 2019 Andrea Parker gave a presentation at a conference held by ME/CFS South Australia. Watch the video here. This one is quite detailed and goes for an hour. The Youtube page lists the contents of the presentation and you can skip to the parts you’re interested in if you wish.

How To Do tVNS For Long Covid

In the following video, Andrea Parker gives a practical rundown on how to use TENS units for tVNS using an ear clip on the tragus part of the ear.

To quickly summarize the video:

1. Not all TENS machines can be used for tVNS. You need a device where you can customize the settings. The best ones have been adapted for tVNS and have a very low range. Andrea recommends the Parasym.
2. The vagus nerve passes through the ear at the cymba conchae and the tragus. The tragus is the best option to use.
3. You’ll need a special ear clip for tVNS that attaches to the tragus. Some TENS devices sellers have them. The earclip needs to have two electrodes, not just one.
4. You need a low intensity range.
5. The best/most common settings are:
   1. Mode: Constant/Normal.
   2. Pulse rate: 20-30hz
   3. Pulse width: 50-200us
6. Dropping back the pulse width to 50 can lower the overall intensity if your device is too high.
7. On the Parasym: set the intensity until you can just feel it. If you drop it back too much it may not be effective.
8. Duration depends. Start low and slow (20hz, 50us), one minute a day and build up over time.
9. Some people report sleep disturbance if tVNS is done later at night.
10. tVNS is mostly safe and has few side effects but discontinue use if you experience lightheadedness, dizziness, chest pain, or excessive skin irritation.

tVNS Devices For Long Covid

The following tVNS (TENS) devices are suggested by Andrea Parker and Dawn Wiley. These devices are programmable and can be used with ear clips. The cost varies according to location.

EV-820. Available from Tragus Clip, an Australian company. It is programmable and battery operated. Tragus Clip will pre-program the device for you according to your own parameters or else set at 25hz, 50uS and a 5 minute timer. You will need to buy the ear clip separately. Tragus Clip sells those as well.

NeuroTrac MultiTENS. Available mainly in Europe, UK, Australia, NZ, Singapore and South Africa. Programmable. Can increase amps by 0.5mA. Uses batteries. Ear clip needs to be sourced separately.
To setup:

1. Turn on the device with the power button.
2. Press PRG1 several times until you see PC1. Choose PC1 (custom).
3. Take off battery cover and press SET.
4. Clock icon flashes. Use + and – buttons. Choose duration of session – 1 minute at the beginning.
5. Press the left MINUS button. “NMS” flashes. Cycle until you get CON for constant.
6. Press the left MINUS button again. Choose your Hertz – 20hz to begin with, no more than 30.
7. Press left MINUS button again. Choose your microseconds. 50 to start, no more than 200.
8. Press left MINUS button to cycle through choices and make sure it’s all good.
9. Turn machine over and press ESC button. That stores the program you’ve just created. If you push the small button to the right of ESC it will lock in your program.
10. Plug in clip, attach to ear.
11. Press the left plus button. This increases the intensity. Push until you just feel it. Don’t go above 5mA at the start.

Med-Fit Premier Rechargeable dual channel TENS. Available only in UK/Europe. Programmable. Can increase amps by 1.0mA. Ear clip needs to be sourced separately.

To setup:

1. Turn on the device with the power button.
2. Press MODE several times until you get N (for Normal), It should have TENS on the screen above it.
3. Press SET for Pulse Width. Use the small up ^ and down ˅ arrows. Set the Pulse Width to 50, up to 200.
4. Press SET again for Hertz. Use the small up ^ and down ˅arrows. Set the Pulse Hertz to 20, up to 30.
5. Press SET again for duration. Use the small up ^ and down arrows. Set for 1 minute at the start.
6. Plug in clip, attach to ear.
7. Press the left elongated up and down arrows to set intensity. Up until you can feel it then go down 1.

Personal TENS and EMS Machine MH8000P. Available in Australia. Programmable. Can increase amps by 1.0mA. Battery operated. Ear clip needs to be sourced separately.

To setup:

1. Press the power button
2. P1 to P3 are programmable. So you can change that by selecting the P+ or P- buttons if you like. Easy to just start with P1.
3. Press the M button. That gives you Pulse Hertz. Press P+ or P- to choose 20, up to 30.
4. Hit SET. This gives you Pulse Width. Press P+ or P- to choose 50, up to 200.
5. Hit SET again. Now you set the duration. Press P+ or P- to choose. The device may not offer less than 5 minutes so you may need to set a separate timer if you want less time.
6. Hit SET again. A little “N” will flash. This stands for “Normal”. Hit SET again.
7. Press M to exit.
8. Plug in clip, attach to ear.
9. Press the up arrows on either CH1 or CH2 (Mhz selection) until you feel sensation in your tragus

TensPro inTENsityTwin Stim III digital TENS EMS combo. Available in the USA. Programmable. Can increase amps by 1.0mA. Battery operated. Need to buy a pair of single ear clips.

To setup:

1. Press the power button
2. Press M until the little square is around the word TENS
3. Press S.
4. Press the up button until square is around N (Normal mode)
5. Press S to bring up blinking clock. Choose your duration, 1 minute to start.
6. Press S again to bring up Pulse Width (PW). Use arrow buttons to choose 50, up to 200
7. Press S again to bring up Pulse Rate (PR) which is Hertz. Use arrow buttons to choose 20, up to 30
8. Plug lead into channel 1. Attach ear clip.
9. Push the up arrow to start the session. This will also increase intensity until you can feel it, or to desired mA.

Parasym. Available in the UK, Europe and Australia. Not available in the US. This is the device that has been specifically designed for vagus stimulation via the ear. It’s not cheap. Programmable. Battery operated. Ear clip included.
Read the Parasym Quick Start Guide for instructions.

Other Devices and Places To Buy tVNS TENS (A general listing… these devices haven’t been recommended or reviewed)

Homemedics TENS and EMS – Sells ear clips.

TENS Machines Australia – Has a variety of TENS machines

Vagus.net – Sells a tVNS stimulator with ear clip included.

DIY Transcutaneous Vagus Nerve Stimulator – Hacking a TENSPros inTENSity unit.

Another Warning: This is all experimental. A lot more research needs to be done on the efficacy of tVNS (Yap, 2020). Using tVNS is undertaken at your own personal risk. Devices should be used in accordance with the manufacturers instructions.

Also, tVNS should not be used by pregnant people, those with implants such as cochlear implants, vagus nerve stimulators, cerebral shunts or other implants. Those with cardiac problems should be very wary. tVNS should not be used by those with skin irritations or problem skin. Again, talk to your doctor about the possibility of trying tVNS, whether it is safe for you and suits your personal circumstances. This page and website is not medical or clinical advice.

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Links

A Vagus Adventure AVA – Dawn Wiley – A private Facebook group that discusses tVNS for ME/CFS and Long Covid

References

Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep. 2021 Jul 7;11(1):14042. doi: 10.1038/s41598-021-93546-5. PMID: 34234251; PMCID: PMC8263555.

Marques KC, Silva CC, Trindade SDS, Santos MCS, Rocha RSB, Vasconcelos PFDC, Quaresma JAS, Falcão LFM. Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID. Front Cardiovasc Med. 2022 Apr 29;9:862001. doi: 10.3389/fcvm.2022.862001. PMID: 35571200; PMCID: PMC9098798.

Acanfora D, Nolano M, Acanfora C, Colella C, Provitera V, Caporaso G, Rodolico GR, Bortone AS, Galasso G, Casucci G. Impaired Vagal Activity in Long-COVID-19 Patients. Viruses. 2022 May 13;14(5):1035. doi: 10.3390/v14051035. PMID: 35632776; PMCID: PMC9147759.

Papadopoulou M, Bakola E, Papapostolou A, Stefanou MI, Gaga M, Zouvelou V, Michopoulos I, Tsivgoulis G. Autonomic dysfunction in long-COVID syndrome: a neurophysiological and neurosonology study. J Neurol. 2022 Sep;269(9):4611-4612. doi: 10.1007/s00415-022-11172-1. Epub 2022 May 10. PMID: 35536408; PMCID: PMC9086662.

Lampros M, Vlachos N, Zigouris A, Voulgaris S, Alexiou GA. Transcutaneous Vagus Nerve Stimulation (t-VNS) and epilepsy: A systematic review of the literature. Seizure. 2021 Oct;91:40-48. doi: 10.1016/j.seizure.2021.05.017. Epub 2021 May 24. PMID: 34090145.

Yuan H, Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part II. Headache. 2016 Feb;56(2):259-66. doi: 10.1111/head.12650. Epub 2015 Sep 18. PMID: 26381725.

Farmer AD, Albu-Soda A, Aziz Q. Vagus nerve stimulation in clinical practice. Br J Hosp Med (Lond). 2016 Nov 2;77(11):645-651. doi: 10.12968/hmed.2016.77.11.645. PMID: 27828752.

Badran BW, Huffman SM, Dancy M, Austelle CW, Bikson M, Kautz SA, George MS. A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms. Res Sq [Preprint]. 2022 Jun 21:rs.3.rs-1716096. doi: 10.21203/rs.3.rs-1716096/v1. PMID: 35765566; PMCID: PMC9238186.

Verbanck P, Clarinval AM, Burton F, Corazza F, Nagant C and Cheron G, Transcutaneous Auricular Vagus Nerve Stimulation (tVNS) can Reverse the Manifestations of the Long-COVID Syndrome: A Pilot Study, Advances in Neurology and Neuroscience Research, 2021.

Traianos E, Dibnah B, Lendrem D, et al. The Effects Of Non-Invasive Vagus Nerve Stimulation On Immunological Responses And Patient Reported Outcome Measures Of Fatigue In Patients With Chronic Fatigue Syndrome, Fibromyalgia, And Rheumatoid Arthritis. Annals of the Rheumatic Diseases 2021;80:1057-1058

Yap JYY, Keatch C, Lambert E, Woods W, Stoddart PR, Kameneva T. Critical Review of Transcutaneous Vagus Nerve Stimulation: Challenges for Translation to Clinical Practice. Front Neurosci. 2020 Apr 28;14:284. doi: 10.3389/fnins.2020.00284. PMID: 32410932; PMCID: PMC7199464.