New Treatment Option for Dysautonomia: Vagal TENS
Based on the findings of recent literature, non-invasive vagal nerve stimulation (VNS) is a new treatment modality that we’ve been including in the management of our clients presenting with autonomic dysfunction at Breathing Works.
What is vagal TENS?
Transcutaneous electrical nerve stimulation (TENS) has been used historically by physiotherapists and individuals at home to manage a variety of acute and chronic pain conditions. More recently, interest has grown in its use to stimulate the Vagus nerve. When a small clip is placed upon the tragus (the pointy bit of the external ear) or with pads on the anterior neck, the Vagus nerve can be stimulated.
The Vagus nerve is the primary nerve within the parasympathetic branch of the autonomic nervous system. It controls our bodies relaxation response, conserving energy and regulating functions such as heart rate, blood pressure, digestion and our immune system, and helps modulates the inflammatory response.
In healthy individuals, the Vagus nerve opposes the "fight-or-flight" actions of the sympathetic nervous system, managing stress and returning the body to a state of calm and balance. Therefore, stimulating the Vagus nerve via TENS is promoting an upregulation of the parasympathetic nervous system.
Who may benefit from vagal TENS clinically?
Dysfunction of this nerve, also referred to as "low vagal tone," is implicated in a number of chronic health conditions, including those characterised by dysautonomia. Clinically, we are seeing value for our patients presenting with Postural Orthostatic Tachycardia Syndrome (POTS), ME-CFS and Long COVID.
There is emerging literature supporting the use of Vagal TENS in patients with POTS, both with and without Long COVID (1-3).
A recent study by Stavrakis et al (2024), found that participants with POTS who received vagal TENS experienced a smaller increase in heart rate after standing, a reduction in antiadrenergic autoantibodies and inflammatory cytokines, and improved heart rate variability compared to the controls.
Similarly, Wang et al (2025) performed a randomized clinical trial on 57 patients with POTS and Long COVID and found that low-level tragus stimulation significantly reduced the increase in heart rate from lying to standing, as well as reducing the average maximum heart rates and also found improvements in heart rate variability. Additionally, they found a reduction in plasma neuropeptide Y levels, an indicator of sympathetic nervous system activity. The positive effects of the treatment persisted for a year.
Two small pilot studies have also indicated a potential clinical application of vagal TENS for individuals with Long COVID. The treatment was found to improve cognitive function, anxiety, depression, sleep and fatigue within a small female cohort (4) and may have mild to moderate effects in reducing mental fatigue in some individuals, but larger studies are required to prove effectiveness (5).
Other population groups which research has been exploring the benefit of vagal TENS for includes improving fatigue associated with Sjögren's Syndrome (6).
Our findings in clinic..
When being used long term, we have been finding Vagal TENS is producing 10-20% improvements in our clients that had been seeing minimal previous progress with other management strategies alone.