Best Vagus Nerve Stimulation Device

Many health conditions we might consider ordinary can drastically reduce our quality of life. Recurring headaches can put a halt to the day, a poor night’s sleep can drain our tank before the day truly starts, and stress can make us feel as though the day will never end.

But you can take action against these common problems, and vagus nerve stimulation is one potential solution. Though it was once an invasive form of therapy that involved surgical implantation, it’s now accessible by way of at-home commercial devices. In this guide, we discuss the four best vagus nerve stimulation devices on the market and examine the science that supports their applications. Along the way, we’ll relay our personal experiences with these devices, as well as some tips for minimizing the expense of using them.

Check out our summary of recommendations directly below for the quickest rundown. Then read further to get the finer details that informed our choices.

Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions about staying healthy and living healthier lifestyles.

Our research into vagus nerve stimulation has involved more than 200 hours with our eyes on the scientific literature and our hands on the devices themselves. To date, we’ve consulted around four dozen credible scientific sources on the subject, including trials on the specific products we’ve tried, and have put several weeks into personal testing so that we can provide a first-hand perspective on what it’s like to be a frequent user.

Additionally, like all health-related content on this website, this guide was thoroughly vetted by one or more members of our Medical Review Board for accuracy and will continue to be monitored for updates by our editorial team.

Our assessments of the best vagus nerve stimulation devices centered on five criteria that are likely to influence consumer choice:

• Effectiveness: How likely is the device to provide symptom relief? What does the science say? What about our testers?
• Safety: Which device poses the least risk of common side effects, such as dizziness and treatment site reactions?
• Total cost of ownership: Is the device within reasonable financial means? If there are any ongoing costs, what do they amount to?
• Ease of use: What hurdles or learning curves, if any, will you need to overcome to use the device?
• Comfort: How does it feel to use the device? Will the experience facilitate or hinder compliance with therapy?

We’re happy to say that each of our recommendations makes a terrific showing in at least one category. See below for the breakdowns.

Effectiveness

Winner: Truvaga Plus

Our choice of Truvaga Plus as the most effective vagus nerve stimulation device takes multiple variables into account.

One is certainly its electrical operating frequency of 25Hz, which is within the 20-100Hz range used in successful clinical studies, but frequency doesn’t reveal the whole picture.1 2 All of our recommendations operate within that range, after all, and each one boasts proprietary characteristics that are difficult to rank in terms of being more or less efficacious for therapeutic benefit.

So we also looked at Truvaga’s similarity to gammaCore, a prescription product that the FDA has cleared as a treatment for cluster headache.3 Made by the same parent company (electroCore, Inc.), Truvaga Plus and gammaCore both emit 5,000Hz electrical pulses at a 25Hz frequency, which are the same parameters found to be effective at treating stress-related psychiatric disorders and increasing mental responsivity.4 5 Also, gammaCore was subjected to a head-to-head study in which it outperformed Xen (another of our recommendations) in improving markers of fatigue and focus.6 Seeing as Truvaga Plus is essentially the non-prescription version of gammaCore, we felt confident that the science solidly supported its status as the superlative stimulator on the commercial market.

The final variable we considered is our testers’ subjective experiences. In their assessments, they found that Truvaga Plus provided the fastest and most noticeable effects for focus, stress, and sleep quality. Xen, Pulsetto, and VeRelief were also therapeutic but milder in their effects. In the end, Truvaga Plus was the product they would buy for themselves.

Safety

Winner: Truvaga Plus

Safety is another category in which we focused much of our attention beyond the scientific literature to designate Truvaga Plus as the winner.

According to a 2018 systematic review, vagus nerve stimulators are generally safe and well tolerated when used within common parameters, and all of our recommendations fulfill the “common parameters” criterion.7 Also, in our testing, side effects were mostly nonexistent. The only device that raised any immediate safety issues was Xen, as its high intensity and earpiece form factor may have led one of our testers to experience inflammation in their ear canal, along with consequent symptoms like vertigo and fever. (The exposure to sensitive skin characteristic of earpiece devices is why most of our recommendations are cervical stimulators used on your neck.)

So, among our three cervical vagus nerve stimulators, Truvaga again rose to the top because of its technical similarity to gammaCore. Remember, gammaCore is FDA-cleared, meaning that it’s “substantially equivalent” to an existing marketed device deemed to be safe.8 It’s also CE-marked, which indicates it has been assessed by the European Commission to “meet high safety, health, and environmental protection requirements.”9 Truvaga’s being near-identical to its cleared and marked cousin assures us that it, too, meets such safety standards.

Pulsetto and VeRelief Prime don’t provide the same level of assurance. That isn’t to say they’re unsafe, only that they lack the third-party validation we like to see in our preferred products.

Total cost of ownership

Winner: Pulsetto

We think a chart should clearly lay out the cost advantage that Pulsetto provides (prices are rounded up to the nearest dollar where applicable):

(Note 1: The costs are based on brand-specific purchases and brand-recommended purchase models; actual costs of ownership can vary depending on several variables. Note 2: VeRelief’s total cost of ownership doesn’t sum logically from its device and conductivity medium costs. It’s a complex issue that we cover in VeRelief’s dedicated section later on.)

You can see that Pulsetto has the widest price range of all our recommendations. The low end of the range is more than $100 less than Xen, and the high end is lower than all but Xen. You reach the high end by purchasing the premium app and re-upping your conductivity gel as one-time purchases, whereas the low end is reached by forgoing the premium app and purchasing the three-month Gelbox subscription plan.

But here’s the thing:

• The premium app probably isn’t worth the added cost for most people.
• A single Gelbox order could reasonably last six months.

So your likely best course of purchasing action — skipping the app and canceling the Gelbox subscription after just two billing cycles — happens to be the more economical choice, which saves you a huge chunk of money compared to our other recommendations.

And here’s another thing: you can purchase the gel (Signa Gel by Parker Labs) elsewhere for as low as $65 for a two-year supply. Realistically, then, the low end of Pulsetto’s total-cost-of-ownership range is more like $334.

(Alternatively, you could use regular over-the-counter saline solution, which is electroconductive. That’s what Xen uses, and it would reduce your total cost of ownership even further. But as we can’t speak to the relative electroconductivities of saline versus Signa products, we recommend using the type of medium that comes with your device.)

Ease of use

Winner: VeRelief Prime by Hoolest

VeRelief Prime wins our Ease of Use category because of its self-contained operation. By that, we mean two things:

• No app: The whole thing works by way of two buttons on the device itself. These buttons allow you not only to increase or decrease intensity but also to cycle through the five output modes.
• No gel or spray: VeRelief’s gel tips come generously applied with conductivity medium. All you have to do is replace the gel tips every month.

While there’s a slight learning curve involved with VeRelief, it’s a much shorter and gentler curve than Xen’s. All you do is hold down both buttons to access your output mode selection, click either button to select a mode indicated by a flashing light, and again hold both buttons to enter the selected mode. From there, just place the gel tips on the side of your neck and press the buttons to adjust your intensity.

If you prefer an app-connected device, our recommendation is Truvaga Plus. Besides being the most effective device we’ve studied and tried, it works with an app whose interface is simple and intuitive. There’s no clutter, and you could probably navigate it fully without a glance at the user manual.

Comfort

Winner: Xen by Neuvana

The only vagus nerve stimulator that our testers described as feeling good is Xen, the lone auricular (ear) device. And by “good,” they mean the way that acupuncture can feel good — enjoyable in a highly unusual sense. In one tester’s words, “It’s like scratching an itch in your ear canal.”

With the other devices, all cervically applied (meaning on your neck), the sensation was more like a mild, transient paralysis of the jaw muscles. They weren’t painful; the feeling was just initially alarming in the way that any paralysis is.

Xen is also comfortable to wear. The device is light, and the earphones fit snugly in the ear canals. The only other hands-free device we recommend, Pulsetto, wasn’t nearly as easy to wear around the house. For slender necks, it hangs like a collar on a cartoon canine, and on broader necks, it feels like a barber’s cape wrapped too tightly.

Our recommendation here comes with a caveat that relates to the safety issue we discussed earlier. Should you over-intensify a Xen session, you run the risk of causing a skin site reaction in your ear canal (an area of thin, vulnerable skin) that may lead to inflammation, which is absolutely not a feel-good sensation. After that happened to one of our testers, their subsequent sessions were uncomfortable. So, please practice moderation with your Xen intensity.

Vagus nerve stimulation is a type of therapy that entails altering the signals in the vagus nerve through electrical pulses.

The vagus nerve (or nerves, as it’s a pair often regarded singularly) is the longest nerve of the autonomic nervous system, which regulates involuntary bodily functions such as heart rate, blood pressure, and breathing.10 It’s also the primary communication channel in the gut-brain axis, a bidirectional network of signaling pathways with physiological, emotional, and cognitive health implications.11 12 As such, the vagus nerve can affect not only how your body functions but also how well your brain works and how good you feel (more on the mechanism of action and potential benefits a little ways down).

Originally, vagus nerve stimulation involved implanting a device that transmitted pulses from within the body, like a pacemaker. But nowadays we have transcutaneous vagus nerve stimulation (tVNS), a noninvasive form of therapy that emits electrical pulses via electrodes placed on the skin’s surface in areas where electrical stimuli can easily access the nerve:

• The ear (transcutaneous auricular vagus nerve stimulation, or taVNS)
• The sides of the neck (transcutaneous cervical vagus nerve stimulation, or tcVNS)

With tVNS, an electroconductive medium, such as saline or an electrolyte gel, is applied to the electrodes or the skin to facilitate electrical transmission through the skin and to the vagus nerve.

The vagus nerve originates from the lower brainstem, at the medulla oblongata, which helps control critical processes such as breathing, blood pressure, and heartbeat.13 From there, it extends behind the ears and down the neck, beside the carotid artery and internal jugular vein, and down to the digestive tract. Between its origin and its endpoint, it passes through or connects to the neck, heart, and lungs.14

So, say you place a tVNS electrode in your ear canal or on your carotid pulse point. When the electrical pulses pass through the electrode (and the conductivity medium) into your skin, they activate neurotransmitters and their receptors in your brain.15 In the case of something like a mood disorder, where neuronal communication may be disrupted, this ability to facilitate neurotransmission may help restore or stabilize the correspondence between neurons for healthy function.16 17

The same communicative principle applies to other health conditions, including, but not limited to, epilepsy and poor sleep.18 19 Additionally, because of the vagus nerve’s role in the autonomic nervous system, electrical stimulation can impart healthful effects on disorders related to physiological homeostasis, such as headache,20 chronic pain,21 and inflammation.22

In clinical studies, researchers have used specific frequency ranges to achieve health outcomes in these areas. Most successful studies have used a range of 20-30Hz, but frequencies up to 100Hz have also yielded pronounced effects.1 2

Based on what we’ve covered so far, you may have inferred how wide-ranging the potential benefits of vagus nerve stimulation are. Below, we outline some of the clinical research detailing the extent to which this therapy can help in diverse areas of health.

According to the authors of a 2018 systematic review, commercial vagus nerve stimulation devices are generally safe and well tolerated when used within common parameters (e.g., 20-100Hz frequencies).7 All of the recommended products in this guide meet that criterion, and one of them — Truvaga Plus — is technically similar to a device that’s FDA-cleared and CE-marked for treating cluster headaches.

But we’re dealing with devices that transmit electrical currents into your body, so there are indeed risks associated with these devices.

Xen, for example, can achieve a maximum output of 84mA (a measure of how much electrical current flows out of it), which is high enough to cause shifts in your heart’s regular beat pattern.39 Also, even the gentlest device on our list — VeRelief Prime — exceeds an output of 10mA, which poses a risk of respiratory paralysis in some people.39 Keeping that in mind, you should speak with your doctor to determine whether you’re physically fit enough to use a vagus nerve stimulation device.

Apart from the above, vagus nerve stimulators can cause various side effects, both minor and major, such as:7 15

• Heart palpitations
• Vertigo
• Localized skin reactions (and possible complications thereof)
• Headache
• Dizziness
• Nausea
• Voice alteration
• Hoarseness
• Coughing
• Tingling
• Shortness of breath

Besides these side effects, vagus nerve stimulation is contraindicated in several populations, including but not limited to people with implantable medical devices, metallic implants, or a history of ulcers or fainting (more on contraindications under “Who are they not for?” in the following section).

Again, we urge you to speak with your doctor before using a vagus nerve stimulator yourself. A review of your history and a physical examination can rule out risk factors that may exclude you as a candidate.

Broadly speaking, the vagus nerve stimulation devices in this guide are for adults who (a) are not pregnant or breastfeeding, (b) are comfortable with transmitting electrical pulses into their bodies, and (c) have one or several indicated health conditions, such as:

• A mood disorder
• Migraines or cluster headaches
• Chronic inflammation
• Gastrointestinal problems
• Anxiety or stress
• Trouble sleeping
• Trouble focusing
• Cardiovascular disorders

The last one comes with a caveat, as the application of electrical stimuli itself can pose a cardiovascular risk, especially at high enough current outputs. Among our recommendations, only Xen by Neuvana has a maximum output above 75mA, the level considered by OSHA to be cardiovascularly unsafe, so that’s the device you’d do best to avoid if you’re at higher risk for something like atrial fibrillation.39 But even the other devices could be contraindicated for you if you have a history of arrhythmias, despite research suggesting the health benefits of vagus nerve stimulation for that heart condition.

Ultimately, whether or not you’re heart-healthy, you should speak with your doctor to ensure that any vagus nerve stimulator is suitable for you.

Who are they not for?

The American Association of Neurological Surgeons warns that any one of the following health conditions would contraindicate you for vagus nerve stimulation:40

• Being prone to ulcers
• Being prone to fainting
• Currently receiving other forms of electrical stimulation
• Having a heart abnormality, such as arrhythmias
• Have an abnormally functioning autonomic nervous system
• Have a chronic lung disorder such as asthma or shortness of breath
• Have preexisting hoarseness
• Having only one vagus nerve (you should have both a left and a right vagus nerve, but some people may have one branch removed to treat a health condition, such as severe peptic ulcers)41

To the above list of no-go populations, one or more brands in our guide add the following:

• Children or adolescents under 18 years old
• People with implantable medical devices, such as pacemakers or hearing aid implants
• People with metallic implants near the neck, such as stents, plates, or screws
• People with a history of cancer or head trauma (because of the slight risk introduced by radio frequency signals)
• People with abnormal auricular or cervical anatomy (as the devices may not fit or work as they should)
• Individuals who are pregnant or breastfeeding

The last one is worth examining further. Although some studies suggest that vagus nerve stimulation is safe and effective during pregnancy,42 and one 2025 preprint claims that it can even increase breast milk production,43 the research is currently insufficient for anyone to be confident that vagus nerve stimulation poses no harm to the developing fetus or newborn. Similar uncertainties surround the risk of radiofrequency exposure during gestation.44

Best overall vagus nerve stimulation device

Truvaga Plus, like most of our recommendations, is a tcVNS device — you place it on your neck, not in your ear. But unlike our other recommendations, it has a pedigree that elevates it in the consumer-grade vagus nerve stimulation market.

The Truvaga brand is part of the same company that makes gammaCore, a vagus nerve stimulation device cleared by the FDA to treat cluster headaches.3 Truvaga Plus is technically similar to gammaCore in that it emits the same 5,000Hz pulses at a 25Hz frequency and a 60mA maximum output, the same parameters found to relieve stress-related psychiatric disorders and increase mental responsivity in clinical studies.4 5 Truvaga’s primary differentiators are that it doesn’t require a prescription and has a lower maximum voltage, so it’s more accessible and potentially more comfortable to use than gammaCore.

Pedigree aside, Truvaga Plus gave our testers the best and most consistent results in their user experience assessments. Using it primarily for focus and sleep, they found that their two-minute Truvaga sessions led to noticeable clearances of brain fog, faster sleep latency, and better overall sleep quality.

Their experiences weren’t without problems, though. On numerous occasions, they encountered connectivity issues between the Truvaga device and their mobile phones. Truvaga Plus is an app-connected device, so poor connectivity effectively bricks it until the problem resolves. Had our testers needed to use their Truvaga for, say, a migraine remedy, we imagine their pain symptoms would present a near-blinding obstacle to troubleshooting any Bluetooth problems.

While it’s true Truvaga isn’t the only app-connected device in this guide, it certainly was the only one that showed reluctance to communicate with the app it relies on to function.

Total cost of ownership

Truvaga Plus costs $499 for the device itself, which doesn’t look too bad — only $50 more than Xen — until you account for the ongoing cost of conductivity spray. After adding $45 for a 12-month spray supply, the total cost of ownership increases to $544 after one year, $589 after two, and $634 after three (when Truvaga’s useful life is expected to run out).

But here’s a tip: Truvaga Plus uses a brand of conductivity spray called Signa Spray by Parker Labs. If you purchase the spray from other sources, you can get a year’s worth of it for as little as $2.99 plus shipping.

So, while we recommend buying the device from Truvaga directly — you get free shipping, you can pay via HSA/FSA, and it’s the only way to guarantee you’ll get a genuine Truvaga product — we think the Signa Spray is best sourced elsewhere.

Shipping and refunds

Truvaga Plus ships for free when purchased directly from Truvaga. And our experience tells us that it will arrive bafflingly fast. For us, it took just three days for our order to go from Truvaga’s distribution center in New Jersey to our testers in Kansas.

From the time you receive your device, you have 30 days to decide whether it’s working for you. If you aren’t satisfied, Truvaga will refund your purchase. You’ll be responsible for the return shipping cost.

Considering that clinical studies have seen positive health outcomes in 2-4 weeks, we think Truvaga provides a reasonable guarantee period. Granted, it’s a potentially narrow window between seeing results and deciding on a return.

Note that the satisfaction guarantee is available only to first-time customers.

Best auricular (earpiece) vagus nerve stimulation device, most comfortable

Xen is like Truvaga if you increase the intensity, complicate the app, and stick it in your ear. In other words, it’s effective, but less intuitive and potentially less safe for some users.

To explain, we should start by discussing Xen’s primary positives:

The issue is that these positives have corresponding negatives:

• Safety: Xen’s comfort is largely due to its in-ear form factor, but the same form factor, along with the high intensity capacity, introduces potentially high levels of electricity to a thinner, more vulnerable area of skin in your ear canal.45 Theoretically, then, it poses a slightly higher risk of otitis externa (i.e., swimmer’s ear), which may be associated with transient hearing loss, fever, and the possibility of infection.46 One of our testers suspects that frequent Xen use caused inflammation in their ear canal, which consequently led to vertigo and fever.
• Battery life: Xen’s intensity capacity is also a drain on its battery life. Our testers saw their Xen’s battery power drop to 35% after just six 15-minute sessions (in comparison, their Pulsetto was still two-thirds full after a week of daily multi-session use). Moreover, the charging jack is the same as the earphone jack, so you can’t charge and use the device simultaneously.
• Learning curve: Xen’s customizability might allow you to derive maximal benefit, but you need to invest the time to dial it in. Unless you have the time, not to mention the curiosity to fuel experimentation, you won’t be using Xen to its maximum potential. It’s true that Neuvana’s website suggests a few settings for focus, stress, and sleep, but the opportunity cost might lean and linger in a corner of your consciousness, asking, “Could you see better outcomes if you experimented?”

The negatives, though, can be overcome. Avoid higher intensities unless you feel that your symptoms require them, charge your device overnight at least every 2-3 days, and spend a session or two every day trying out a different setting combination.

Total cost of ownership

At $449, Xen by Neuvana has the second-highest initial cost on our list. Fortunately, its accessory costs are minimal. The conductivity medium used with Xen is a simple saline solution, like contact lens solution or wound wash, and Neuvana even recommends using contact lens solution or wound wash as a replacement when you run out of the saline that comes with your device. That’s maybe an extra $5-$15 for a 12-month supply, so your total cost of ownership after one year is around $454-$464 — significantly less than Truvaga and approximately on par with VeRelief Prime on a subscription plan.

Shipping and refunds

Xen ships for free, the same as Truvaga, Pulsetto, and VeRelief. Expect some fast shipping here, too, as our order arrived in just four days — only one day slower than Truvaga.

Like most of our recommendations, Xen comes with a 30-day satisfaction guarantee. But unlike the others, the guarantee starts on the date of purchase. Realistically, then, you have around 26 days to determine whether Xen is working for you. Also, returns are subject to a 10% restocking fee, so the most you might get back on your original purchase is around $404.

Most affordable vagus nerve stimulation device

Pulsetto is the other hands-free device on our list; you wear it like headphones, except the ends, each with two electrodes, clamp onto your neck instead of your ears.

And like most of our recommendations, it’s an app-connected device through which you activate and control your sessions. The app differs, however, in that it’s available in two versions:

• Basic (free): includes the Stress, Anxiety, Sleep, Burnout, and Pain programs
• Premium (paid): includes the Head Pain, Inflammation, and Gut Health programs, plus options for meditation, breathing exercises, affirmations, and a neuromuscular function test

All programs emit waveforms at a 25Hz repetition frequency, but each one also emits a pulse frequency between 4,500Hz and 5,200Hz. You’ll notice this pattern is similar, though not identical, to that of Truvaga and gammaCore. As it stands, there’s no unaffiliated research examining Pulsetto’s exact parameters. The only studies that support such parameters are Pulsetto-funded master’s theses, which are hardly on the same level as peer-reviewed, placebo-controlled trials.

Yet our subjective experience with Pulsetto was largely positive. Our testers noted appreciable relief from headache, stress, and sleeplessness during their week of daily, multi-session use. The effects weren’t as dramatic as what they felt with Truvaga Plus or even Xen and VeRelief, but they were noticeable. Given our testers’ outcomes, along with the approximate similarity of its parameters to an FDA-cleared device, Pulsetto has earned its place among the best vagus nerve stimulation devices.

One tester, though, had trouble getting Pulsetto to fit properly. She has a slender neck, so the device hung loose like a collar on a cartoon canine. The poor fit didn’t preclude use — she moved the device backward so the ends clamped on her neck — but it did make for a less comfortable experience.

Total cost of ownership

The pricing of Pulsetto is pretty nice. The device itself is $269, which is $120 less than VeRelief Prime outside of a subscription plan. You have to continually re-up your supply of conductivity gel, but the pricing for that is lower than you might expect.

So, your Pulsetto device comes with one tube of Signa Gel. Based on our testing, we’d say a single tube should last at least six weeks. To restore your supply through Pulsetto, you can purchase four fresh tubes either as a one-time purchase for $50.99 or on a three-month subscription plan for $40.79 each cycle. Given how long a tube is likely to last, you’ll probably need only two orders or cycles to meet your needs for a year. Therefore, your total gel expense should be $81-$102, meaning your first-year total cost of ownership comes out to $350-$371.

Mind, you don’t have to purchase the Signa Gel through Pulsetto. Other retailers sell a two-year supply for around $65, so you can bring your first-year total cost of ownership down to $334, which will then be your two-year total cost of ownership.

The premium app is an added expense, of course, but an optional one. Our testers didn’t see much difference in their outcomes between the Basic programs and the Premium ones, but maybe you might. At any rate, your device comes with a 30-day trial of Premium, so you have a month from the date of delivery to decide whether it’s worth the $129 yearly subscription. Even if you tack it on, your total cost of ownership ($463 if you purchase the gel from a separate party) is still lower compared to Truvaga and VeRelief, and possibly even Xen.

By the way, Pulsetto is HSA/FSA eligible and comes with a two-year warranty. Those are also pluses on the financial end of things.

Shipping and refunds

Shipping delays aren’t uncommon with Pulsetto. We ourselves faced a 12-day delay between the time we purchased Pulsetto and the day it shipped out. All told, it took almost 20 days to receive our order.

Fortunately, Pulsetto’s 30-day satisfaction guarantee starts on the date of delivery, as does its 30-day Premium app trial. We recommend, however, that you notify Pulsetto’s customer support team when you receive your order so they don’t erroneously begin your trial or guarantee window at an earlier date.

Also, if you decide to return your Pulsetto within the 30-day period, know that the cost of return shipping will be deducted from your refund. That’s $5-$35 less than your purchase price, depending on your location.

Easiest-to-use vagus nerve stimulation device

VeRelief Prime could be the go-to option for anyone who’d rather not fuss with a mobile app. Its operation is entirely self-contained. Two buttons, “+” and “-”, are all you need to switch between output modes and adjust the intensity. There’s only a gentle learning curve involved, which entails knowing that you have to hold down both buttons to switch and select modes. After that, it ought to be intuitive.

Each of VeRelief’s output modes corresponds to either a frequency or a modulated stimulation cycle that Hoolest claims can help users achieve greater calm:

• Mode 1: 8Hz of constant stimulation. Though the frequency is lower than that of other devices on this list, a 2007 study found that it can impart a mood-enhancing effect.47
• Mode 2: 25Hz of constant stimulation. This is the frequency used by our other picks and most often in clinical studies, including those related to stress-related psychiatric disorders.4
• Mode 3: 100Hz of constant stimulation. In a 2020 study, this frequency imparted a significant effect on a brain region involved in “survival-related responses and homeostatic regulation important for affective responses, nociception, and stress.”48
• Mode 4: 100Hz with a modulated stimulation cycle. Your session proceeds in an on-off pattern of five-second stimulation followed by a five-second rest.
• Mode 5: 100Hz with a different modulated stimulation cycle. Here, the pattern is 15 seconds of stimulation followed by five seconds of rest.

Modes 4 and 5 involve you, the user, exhaling for the duration of each “on” cycle and inhaling during the “off” cycle. With Mode 5 as an example, you would breathe out for 15 seconds, breathe in for five seconds, and repeat — a total of three inhalations and exhalations per minute. Such breathing exercises constitute a natural therapy called respiratory vagus nerve stimulation, which a 2018 review found to show promise for improving mental health and cognitive performance.49 Paired with the external pulses from your VeRelief device, it can potentially increase the stimulating effect on the vagus nerve.

It’s apparent that VeRelief’s parameters are well-supported. But what isn’t supported is the claim that Hoolest seems to make on its website: that VeRelief, specifically, has been the subject of numerous vagus nerve studies.

On the Research page, under a heading titled “Safety Proven in Thousands of Users,” Hoolest either outright states or implies VeRelief has been used in at least four large-scale safety trials, but the linked sources make no mention of VeRelief or Hoolest, and the one uncited study is nowhere to be found online. There are also efficacy studies referenced on the page, but most of them are uncited as well. The link for the lone cited efficacy study leads to a 2019 preprint partly authored by Hoolest’s founder, and whose subject isn’t VeRelief Prime but an auricular prototype.50 (Interestingly, the founder wasn’t the paper’s lead author, yet he’s given lead author byline placement on the Hoolest Research page.)

None of this is to say that VeRelief isn’t effective — other studies indicate that its parameters are sound, and our testers experienced noticeable stress relief in their three-to-ten-minute sessions on Modes 3-4 — but it does point to deceptive marketing practices at Hoolest.

Total cost of ownership

Hoolest offers two purchase options for VeRelief Prime:

The subscription plan looks pretty good, saving you at least $32 in your first year of ownership and being roughly the same cost as Xen. But you need to know that it doesn’t make sense. Here’s why:

• The gel tips are supposed to last one month.
• The subscription plan comes with a one-month supply of gel tips.
• You only get another one-month supply of gel tips every two months.

In other words, each subscription delivery cycle requires you to use expired gel tips for a month, which will either not work or work poorly. It happens that Hoolest sells a Gel Hydration Solution that’s supposed to extend the useful life of your gel tips by 30 days. It costs $39, which increases the one-year total cost of ownership of the subscription plan to $488.

The more sensible option, then, is to purchase VeRelief on its own ($399), get the Gel Hydration Solution ($39), and subscribe to gel tips separately, pausing your order as needed ($10.36 per order). If the box comes with a four-month supply of tips, the Solution could feasibly extend the useful life to eight months, so you’d need just two additional months’ worth to finish out the year — a first-year total cost of ownership of $458.72.

One last thing about VeRelief is that its use of proprietary gel tips ties you to ongoing payments to the brand. You might be able to use a less expensive conductivity gel as a substitute for the Solution, but we can’t verify how effective that would be.

Shipping and refunds

VeRelief ships for free and ought to arrive in about a week. Not the fastest shipping turnaround, but much better than what we experienced with Pulsetto.

Where VeRelief has a definite edge on its competitors is its 60-day satisfaction guarantee, which is twice as long as that of any other brand on our list. The downside is that you, the customer, are responsible for the return shipping. There’s also a $10 processing fee, which is at least lower than Xen’s and potentially lower than Pulsetto’s.

For those of you who aren’t keen on trying electrical stimulation, there are many good supplemental alternatives on the market. They may not boast as broad a therapeutic range as a vagus nerve device, but they have a much more familiar mode of administration and significantly lower financial barriers to entry. Here’s what we recommend in place of vagus nerve stimulation in the following areas of health:

As for other health concerns, like chronic headaches and epilepsy, we recommend speaking with a doctor to explore prescription options. Medications like sumatriptan can help prevent the escalation of a cluster headache, and anticonvulsants can help manage epileptic seizures.