Pulsetto Reviews

You’ve likely suffered a headache or a poor night’s sleep at some point in your life. Probably, the demands of work or school have overwhelmed you, too. It wouldn’t be unimaginable if all such problems were to fall on you on the same day.

Were that to happen, a device like Pulsetto might be able to help. Emitting high-frequency electrical waveforms at a clinically studied frequency, Pulsetto can alter the signals in your vagus nerve to impart a range of potential benefits for pain, mood, and more. In our Pulsetto review, we examine how it works, measure it against competitors, and report our testers’ experiences with the product.

Pulsetto represents a relatively low-cost entry point in the at-home transcutaneous vagus nerve stimulator (tVNS) space. Even with ongoing expenses like conductivity gel and (if you’d like) a premium app subscription, the total cost of ownership after 1-2 years is lower than that of a competitor like Truvaga Plus. Our testers saw decent outcomes in subjective stress and sleep quality markers. At the same time, Pulsetto boasts less scientific support for its exact operating parameters than Truvaga does — currently, the only research that specifically favors Pulsetto comes from thesis candidates who received funding from Pulsetto. And though our testers felt therapeutic effects, they agreed that those benefits with Pulsetto were milder compared to Truvaga. So in a nutshell, this seems to represent an opportunity to achieve more modest improvements at a lower price.

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Our Pulsetto review builds off of the research we started with a competitor, Truvaga. As we write this, our research hours into transcutaneous vagus nerve stimulation exceed 130 hours. That includes the time we’ve put into hands-on testing and company correspondence, not just the close readings of scientific literature. With our holistic approach to understanding the therapeutic space Pulsetto occupies, we can present the most complete picture possible of its merits and shortcomings.

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.

We based our overall rating of Pulsetto on five factors that are likely to influence consumer decisions:

• Effectiveness: Does Pulsetto do what it says it does? What science is there to support it?
• Safety: What health risks, if any, does it pose to a general audience? What about specific populations?
• Cost: Vagus nerve stimulators are often expensive. How does Pulsetto compare in that regard?
• User experience: What’s it like to use the device and its connected app? Are there any issues I might encounter?
• Customer experience: How easy or difficult is it to deal with Pulsetto’s customer support team? Should you expect any obstacles?

Let’s see how Pulsetto performed in each category.

Effectiveness

It has a lot to do with our testers’ positive experiences that Pulsetto’s effectiveness rating rises on tiptoe above the midpoint. In their week of daily multi-session use, they felt noticeable relief from frequent ailments such as sleeplessness, stress, and stress-related headache. For them, Pulsetto and the associated programs in the connected app did what they advertised, albeit not to the same degree as they had with a competitor, Truvaga Plus.

The upward-leaning score also has to do with the similarities between Pulsetto’s operating parameters and those of an FDA-cleared device called gammaCore. The well-tested, prescription-only gammaCore emits a pulse frequency of 5,000Hz with a pulse-repetition frequency of 25Hz, which studies have found to be effective in treating stress-related psychiatric disorders in two-minute sessions, as well as in increasing mental responsivity.1 2

But similar isn’t identical. Pulsetto’s pulse frequencies deviate from 5,000Hz by several hundred hertz in either direction, depending on the chosen treatment program, and such deviation can mean a significant difference in efficacy. Also, as it stands, the only studies that support Pulsetto’s exact operating parameters are thesis-level research funded by Pulsetto itself.

With all that considered, along with our testers’ preference for a competitor, we think Pulsetto is decently effective but not superlatively so.

Safety

Vagus nerve stimulators are generally safe and well tolerated when used within common operating parameters,3 and because Pulsetto’s parameters hew pretty close to gammaCore’s, we’d say they fit that mold. Moreover, Pulsetto is certified by the Federal Communications Commission, meaning that its radio frequency emissions are within safe levels.4 5 In terms of your exposure to electromagnetic radiation, using Pulsetto ought to be no more hazardous than operating your cell phone.

Having said that, we acknowledge that Pulsetto’s maximum output of 30V is greater than gammaCore’s, and that may increase the risk of side effects both minor and major — for example, headache, dizziness, heart palpitations, and skin reactions6 — and the dearth of research into its exact operating parameters leaves specific safety questions unanswered.

Again, though, we can point to our testers as evidence that Pulsetto is more safe than not. One of them discovered only too late that he was contraindicated for use because of a metallic implant in his jaw, yet he experienced no ill effects as a result.

Cost

Compared to other products in a relatively high-cost space, Pulsetto represents a bargain. Here’s a table to illustrate:

(Note: The conductivity medium refers to the electrolyte gel or spray sold through the company website. You don’t have to buy these products through the website or even the specific brands they sell. In fact, it’s much less expensive to buy them elsewhere. But we’ve used the brand-specific products in the table as a way to standardize pricing as much as possible. You’ll see more nuanced price breakdowns later in this review.)

You see that Pulsetto’s total cost of ownership after one year is a pretty wide range. You reach the top end of the range only if you purchase the premium app on a month-to-month basis (not recommended for everyone) and are over-generous with your use of electrolyte gel. Even then, the cost is less than Truvaga Plus and Xen after one year. And on the low end, Pulsetto’s one-year total cost of ownership beats all the other competitors by a wide margin.

User experience

Pulsetto’s size-adjustable, hands-free form factor visibly sets it apart from competitors Truvaga Plus and VeRelief Prime, which the user must manually hold to their neck for 2-10 minutes to operate. Most Pulsetto sessions are ten minutes long but can be adjusted to be as brief as four, and our testers found it much less intrusive to their schedules to wear Pulsetto for longer sessions than to pause all other activities to complete a shorter session with Truvaga or VeRelief. If you’re so inclined, you could complete your Pulsetto sessions while doing other activities, like working out or preparing dinner, as one of our testers did.

Unfortunately, hands-free operation, even with a size-adjustable device, is more of a burden than a boon for people with slender necks. One of our testers, for example, has a 14in neck circumference, and the device’s electrodes extended away from skin contact by at least a finger’s breadth. She had to move the device backward so that the electrodes clung to her neck by friction, which forced her to limit her movement during sessions.

The connected app, at least, is intuitively designed. Without reading a manual, you could probably navigate your way to and through a session without a hitch. Most of the programs’ names clearly indicate what they’re supposed to do, and the session interface clearly marks options for increasing intensity and adjusting the time frame.

But an app interface isn’t ideal in all situations. Let’s take, for example, a headache, one of the ailments that vagus nerve stimulation can treat. Imagine your head explodes with pain with every heartbeat and your phone’s Bluetooth won’t connect to your Pulsetto device. How swiftly do you think you could troubleshoot the connection problem so that you can find symptom relief?

There’s also the matter of the paid version of the Pulsetto app — called Pulsetto Premium. It’s through this version that you get the treatment programs for Head Pain, Inflammation, and Gut Health, as well as supplemental features for meditations, breathing exercises, and affirmations. The three extra treatment programs could be useful, yes, but the supplemental features seem as though their purpose is to justify the existence of a paid tier. Aside from our testers having had no use for them, similar features are widely available through other (free) apps and platforms. So, depending on what ailments you normally experience, you might be better off sticking with the basic app and using the Stress or Pain program to treat things like headache and gastrointestinal pain.

Customer experience

The customer experience with Pulsetto is an evenly distributed mix of good and not-so-good.

On the good side, there’s a 30-day satisfaction guarantee and a decently responsive support team. True, the only way to contact Pulsetto is by email, the slowest of the common communication channels for customer support, but the company’s reps have been good about responding to our queries within 1-2 days. Seeing as many companies we’ve reviewed have taken up to a week just to acknowledge our emails, we commend Pulsetto’s attentive turnaround. We especially appreciated the quick refund we received — on a weekend, no less — on an erroneous charge for Pulsetto Premium before our 30-day trial was up.

On the not-so-good side, the very reason for the erroneous charge seems to be a common issue among Pulsetto’s customers. What happened was that our order had a 12-day delay between purchase and shipment, and the company started our premium app trial on the date of purchase. In effect, we had only half the time we were promised to try the premium app before being hit with an unexpected charge. Again, an email quickly resolved the issue, but we think the issue itself should never have arisen. Bear in mind that Pulsetto’s Trustpilot page displays many instances of similar, if not longer, delays, so you may face the same problem we did.

Pulsetto belongs to a therapeutic space called transcutaneous vagus nerve stimulation (tVNS), a form of electrical pulse treatment. The pulses are delivered not by implant but via electrodes placed on the skin, so it’s fully noninvasive. The electrical pulses, aided by a conductivity medium such as electrolyte gel, travel through your skin and into your vagus nerve.

The vagus nerve is the longest nerve of the autonomic nervous system, starting at the lower brainstem and extending to the digestive tract. Along the way, it passes through or connects to the neck, heart, and lungs.7 The nerve’s placement in the body allows it to be stimulated auricularly (by the ear canal) or cervically (by the neck).

By stimulating the vagus nerve, tVNS can potentially alter neuronal signals that affect multiple regions of the brain and the body, imparting relief for conditions such as:8 9

• Epilepsy
• Mood disorders
• Chronic pain
• Headache, including cluster headache
• Cardiovascular disorders10
• Stress1
• Sleep disorders11
• Cognitive function and attention12 13

The ability of tVNS to provide these health benefits may depend on the operating frequency used. Most clinical studies have used a 25Hz frequency, which appears to improve biomarkers related to stress, but others have seen benefits from higher frequencies (e.g., 100Hz leading to the greatest decrease in heart rate, suggesting a more pronounced effect on stress) as well as lower ones (e.g., 20Hz for improved cardiovascular health).14 15

Pulsetto is a hands-free device similar to headphones, except the ends clamp onto the sides of your neck rather than your head. At each end are two electrodes oriented vertically. Before each session, you’re to apply a small amount of the included electrolyte gel either directly to the electrodes or to the treatment sites on your skin (i.e., the areas that align with your carotid pulse).

Pulsetto is an app-connected device. As with competitors Truvaga Plus and Xen, the app is the hub through which all sessions take place. You activate your phone’s Bluetooth, connect Pulsetto to your phone, and then select a treatment program through the app interface.

There are two versions of the Pulsetto app:

• The basic (free) version has programs for Stress, Anxiety, Sleep, Burnout, and Pain.
• The premium (paid) version includes programs for Head Pain, Inflammation, and Gut Health, as well as meditation programs, breathing exercises, affirmations, and a test to evaluate your neuromuscular function.

Each treatment program emits a specific pulse frequency, each at a 25Hz pulse-repetition frequency (PRF) — a common frequency used in clinical research.14 The Stress program, for example, produces a 4,500Hz pulse frequency. In relation to the PRF, that means the device emits 4,500 electrical oscillations in every pulse, with 25 pulses per second. The pulse frequency ranges up to 5,200Hz depending on the program you choose.

Some tVNS studies have used a similar but not identical electrical pattern — a 5,000Hz pulse frequency with a 25Hz PRF— including a 2017 study on transcutaneous vagal access via the neck, a 2020 study on treating stress-related psychiatric disorders, and a 2022 study that demonstrated increased mental responsivity in subjects who received noninvasive vagus nerve stimulation.16 1 2 A prescription product called gammaCore, currently the only FDA-cleared and CE-marked tVNS device, also uses a 5,000/25Hz electrical pattern,17 18 19 as does our favorite nonprescription device, Truvaga Plus.

Pulsetto studies

While research supports using the 5,000/25Hz stimulation pattern, the only sources that vouch for Pulsetto’s exact operating parameters are those whose funding came from Pulsetto itself. What’s more, none of them appear to be published in peer-reviewed journals, and two of them are explicitly master’s theses. Still, let’s see how they collected their data and what their findings might mean:

The limitations of these studies are apparent: each had a small sample size, and two of them relied entirely on self-reported measures. Thus, they’re less proof of Pulsetto’s efficacy than of the dearth of research relating to it.

On the other hand, their findings more or less correspond to those of our own testers, who used Pulsetto multiple times daily for a week. We discuss our testers’ impressions in a later section, “Our Pulsetto user experience.”

A systematic review published in 2018 concluded that tVNS devices operating within common parameters are generally “safe and well tolerated.”3 Seeing as Pulsetto’s operating frequencies are mostly similar to those of gammaCore, an FDA-cleared and CE-marked product, we can consider them to be “within common parameters.”

We can also point to Pulsetto’s Federal Communications Commission (FCC) certification as further evidence of its safety. Reports from June 2022 show that the Pulsetto device passed all of its tests for electronic emissions and was granted FCC approval.4 In other words, its radio frequency emissions are within generally non-hazardous limits for its class, much like a cell phone.5

That being said, Pulsetto has a higher maximum output than gammaCore — 30V as opposed to 24V — so it may pose a slightly higher risk of side effects seen in research, such as:3 6

• Headache
• Dizziness
• Nausea
• Voice alteration
• Hoarseness
• Coughing
• Tingling
• Shortness of breath

The 2018 systematic review we mentioned also identified three serious adverse events that could “possibly or probably” be attributed to tVNS treatment: heart palpitations, acute vertigo, and localized skin reactions.3

Because of the diverse treatment potential of tVNS, Pulsetto may be a suitable at-home therapy if you experience:

• Stress or anxiety
• Problems focusing
• Difficulty sleeping
• Chronic pain or headache
• Inflammation
• Gastrointestinal distress

That isn’t to say that Pulsetto can resolve these health problems absolutely, as there may be underlying causes at play, but it may provide some degree of relief so that you can manage your symptoms.

Who is it not for?

Pulsetto and other tVNS devices are contraindicated in people who:25

• Have only one vagus nerve
• Have a cardiovascular condition 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
• Are prone to ulcers
• Are prone to fainting
• Currently receive other forms of electrical stimulation

In addition to the above, Pulsetto warns that its device is not suitable for people with an implantable medical device (e.g., pacemaker, hearing aid implant), a metallic implant near the neck (e.g., stent, plate, or screw), a history of cancer or a head condition (e.g., brain tumor, aneurysm, head trauma), or an abnormal cervical anatomy, as well as children and pregnant women.

Although it’s true that some studies have determined tVNS devices to be safe and effective for use during pregnancy, Pulsetto’s disclaimer holds merit given the uncertainty surrounding the risk of radio frequency exposure during gestation.26 27 So if you’re pregnant and wish to use Pulsetto, you should consult with your physician to ensure that it would be safe for you and the developing fetus.

Pricing with Pulsetto, as with many leading tVNS products, is complex. There are multiple factors that contribute to the total cost of ownership (TCO):

So the first-year expenditure for Pulsetto is around $280 at the low end (with conservative gel use from a third party and sans premium app) and $500 at the high end. In terms of daily use, the per-diem cost equals about $0.77-$1.37. Not bad. Many of the supplements we review have higher per-day use costs.

And compared to other tVNS devices, Pulsetto’s value is excellent. Take Truvaga Plus, for example, which costs $499 for the device alone. Or compare it to Xen or VeRelief Prime, each of which costs around $449 after one year. Financially, Pulsetto occupies probably the most comfortable range for most people, as it offers both a low barrier to entry and a low cost of continued use.

Also, Pulsetto may be HSA/FSA eligible and comes with a two-year warranty. None of its competitors have as long a warranty, and only Truvaga is explicitly HSA/FSA eligible.

Pulsetto’s money-back guarantee

Like Xen and Truvaga, Pulsetto has a 30-day money-back guarantee that starts from the date of delivery. That gives you a month to decide whether Pulsetto works for you. If it doesn’t, and you want a refund, you just complete the form linked on the Refund Policy page of the company’s website. Within 24 hours, the customer support team should email you with confirmation, your authorization number, and instructions for return. Thereafter, you have 21 days from the receipt of the email to get your device, in its original box along with all included accessories, in transit back to Pulsetto. So, altogether, you effectively have a 51-day trial.

Along with our purchasing Pulsetto and interacting with its customer support team, we had our testers use the Pulsetto device multiple times a day for a week straight. In the following sections, we discuss personal and subjective factors such as our purchasing experience, our feelings about the company’s support quality, our opinions of the Pulsetto device and app, and our testers’ therapeutic responses to Pulsetto. (Please keep in mind that our experiences don’t necessarily reflect others’, and your experience may be very different.)

Buying the Pulsetto device

Purchasing Pulsetto posed no problems, but shipping it did. Two days after we completed our purchase, we received an email from the company notifying us about an extended shipping time frame of up to ten days “due to high demand and courier delays.” The actual time frame was longer, and our order didn’t ship out until 12 days post-purchase. A look through Pulsetto’s Trustpilot page suggests that such delays are common, with some customers reporting that it took weeks before their orders arrived.

Fortunately, Pulsetto’s money-back guarantee doesn’t begin until your order arrives, so you’ll have the full 30 days to test the device even if you experience a delay. The same should go for the 30-day trial of Pulsetto Premium, but you may have to email customer support about that (which we did).

Pulsetto’s customer support

The only way to contact Pulsetto’s support team is by email, so while our interactions with them were generally positive, they weren’t as expedient as we would have liked. In our initial exchanges, in which we asked about Pulsetto’s exact operating parameters, we received our first responses on the same day, but subsequent messages took several days to arrive. All told, it took a full week to resolve the question of what frequencies Pulsetto used.

To the team’s credit, they were relatively responsive considering the nature of the communication channel. While their responses weren’t as speedy as the ones we got from competitor Xen, some companies in the space take a week to respond to just the initial message. We wish, though, that Pulsetto would add a phone line or, like Truvaga, a live chat feature on its website.

At any rate, a better experience came later, when we were charged for a Pulsetto Premium subscription well before our 30-day trial had ended. The issue was that the company had started our trial upon the date of purchase, not the date of arrival. We immediately emailed the support team about this issue, but seeing as it was a Saturday, we didn’t expect a response until Monday. Yet the response came just a few hours later — first as a notification of a refund, and then as an explanation of the company’s error. The team then reset our premium app trial so that it aligned with the 30-day window starting from the date of arrival.

Using the device

Our testers — we’ll call them “Ben” and “Jo” — had differing opinions about the Pulsetto device itself.

Ben found that the electrodes rested comfortably against the pertinent areas of his neck; only at first did it feel like an overly tight barber’s cape, but that feeling resolved on its own at around the fourth use.

Jo, however, has a more slender neck that Pulsetto poorly accommodated. She had to position it more rearward so that the “headband” portion of the device rested on her upper trapezius muscles and the electrodes held on by friction rather than organic placement.

The fit difference led to no disparities in therapeutic benefit as long as Jo didn’t disrupt the device’s positioning during her sessions. But that means that she couldn’t use Pulsetto simultaneously with other activities, like working out or preparing dinner, the way Ben could.

Despite using the device multiple times every day, our testers never needed to charge it (they never even unwrapped the charging cable included in the box). Yet the battery life stood at around two-thirds full by the end of the testing week.

The pulsetto app

Ben and Jo found the Pulsetto app easy to use and feature-packed, but they personally saw little value in most of its features.

The interface is split into two tabs: Basic and Premium. The Basic tab has the programs for Stress, Anxiety, Sleep, Burnout, and Pain, and that’s where our testers spent most of their time. The Premium side includes the Head Pain, Inflammation, and Gut Health programs, as well as meditations, breathing exercises, affirmations, and a neurological function test. Our testers derived no benefit from those latter, non-treatment features and didn’t think they did anything to justify the subscription price.

Session times vary depending on the program. The Sleep program, for example, lasts ten minutes by default, whereas the Stress program lasts six. You can also adjust each program’s time frame within a four-minute range — two minutes more or two minutes less — as well as the intensity level from 1 to 9. If you wish, you can customize your session with a file from Pulsetto’s music library, each of which is something that a new-age massage therapist might play in their studio.

(By the way, your device’s battery life is displayed in the lower right-hand corner of the session screen, which is helpful even though our testers didn’t need to recharge their device during the testing week.)

Our testers’ therapeutic responses to Pulsetto

Ben and Jo centered their self-guided treatments on health issues they normally experience: sleeplessness and stress. We contextualize and summarize their impressions below:

Although Pulsetto offers probably the most accommodating price point for effective at-home vagus nerve stimulation, you may prefer a device with more peer-reviewed scientific support behind it. Or maybe you want a tech-free solution instead. In either case, these alternatives may give you what Pulsetto can’t:

Direct competitors

The best nonprescription tVNS device we’ve tried is the app-connected Truvaga Plus. In terms of operating parameters, it’s almost identical to the FDA-cleared gammaCore (made by the same company, in fact). It’s also programmed to have a useful life of at least 30,000 sessions, and our testers claim it has given them the most significant relief from stress, sleeplessness, and brain fog. It’s pricey, though, at $499 for the device and a first-year TCO of $544 after accounting for conductivity medium.

But there are some options that are less expensive than Truvaga Plus, though not as affordable as Pulsetto:

• Truvaga 350: a lower-cost, app-free version of Truvaga Plus. It costs $299 but is also limited to 350 sessions, so it’s not cost-effective for people seeking a long-term solution.
• VeRelief Prime: an app-free device that offers a simpler approach to cervical tVNS than Pulsetto or Truvaga Plus. Rather than a conductivity gel, it uses proprietary gel tips. It costs $399 for the device alone or $249 if you buy it as part of a gel tip subscription. The one-year total cost of ownership ranges from $449 to $511 depending on your choices among various cost variables.
• Xen: an earpiece device that stimulates the auricular branch of the vagus nerve. The device costs $449. The only necessary ongoing purchase is a conductivity medium, and Xen’s support team says you can use something as inexpensive as contact lens solution for that (maybe an extra $10 per year).

Tech-free solutions

A tech-free, albeit precisionless, solution for vagus nerve stimulation is available to most people at most times. Say that you have a cold bottled drink in your hand: you can press it to the side of your neck and potentially lower your stress level via cardiac-vagal activation.32 Or if you have time for exercise, you can enhance your cardiac vagal activity with a quick run or other form of endurance training.33 If nothing else, you can take a few deep breaths to lower your heart rate and affect your autonomic nervous system.34