In part III of our article on vagus physiology, we look at the treatment for these, until recently, little-known but critically important and widespread conditions of the vagus nerve which are the root cause of many illnesses for millions of people worldwide. In parts I and II of this article, we have laid a basic groundwork describing structural problems, or cervical dysstructure, in the neck. Now we will discuss the vagus nerve and dysautonomia.
Let’s first touch on some new research developments that will help explain the impact of vagus nerve dysfunction on health and the role of cervical instability.
symptoms of cervicovagopathy dysautonomia
Dysautonomia is a dysfunction of the nerves that regulate the involuntary functions of the body. Vagus nerve degeneration can be so serious that widespread arterial vasospasm (blocking off blood flow to the body including the brain) can occur. Everything that happens in the body involuntarily, including cardiovascular, gastrointestinal, genitourinary, ocular, respiratory, thermoregulatory, vasomotor homeostatic functions, and a host of other involuntary reflexes can be affected by vagus nerve degeneration.
The PNS, led by the vagus nerve, helps the body rest, digest, and ultimately repair, without which the body goes into disrepair. The sympathetic and parasympathetic systems are in a finely tuned interplay. When sympathetic dominance occurs over a long period of time, characteristic signs and symptoms occur. Let’s examine the illustration below.
vagus and nodose ganglion degeneration findings
Animal studies are done in preliminary research, sometimes animal studies are done when the risk of producing the same study in human beings would be considered unsafe. The amount of neuron (nerve) degeneration correlates with the level of coronary artery vasospasm and animal (rabbit) death. (9)
- The researchers summarized their findings this way: “We found that there is a causal relationship between nodose ganglion degeneration and coronary vasospasm. Our finding could be the reason that many cardiac events occur in patients with subarachnoid haemorrhage (bleeding around the brain). Vagal pathway paralysis (among other conditions, impacting the heart function) induced by indirect sympathetic overactivity (increased heart rate, increased respiration, increased blood pressure) may trigger coronary vasospasm and heart rhythm disturbances.”
Vagal ischemia (loss of blood supply) induces lung (cell and area death) in respiratory arrest from pulmonary artery vasospasms. (10)
- The researchers wrote: “Neurogenic pulmonary oedema is the most serious complication of subarachnoid haemorrhage. As vagal nerves have vital roles in lung functions, vagal ischemia may have a causative role in the pathogenesis of Neurogenic pulmonary oedema.” The researchers examined whether there was a relationship between vagal complex ischemia and lung immune complexes occupying the lymph node infarct (cell death) in subarachnoid haemorrhage.”
- The animals used in this study presented meningeal (the layers of the membrane covering the brain) irritation signs:
- convulsive attacks
- fever
- apnea
- cardiac arrhythmia
- and breathing difficulties.
Degeneration of the vagal renal (kidney) branches caused extreme parenchyma (functional tissue) spastic renal arteries leading to Glomerulonephritis (inflammation of the small filters in your kidneys) and kidney cell death at a 17 times greater rate than normal. This problem also results in sodium retention leading to severe hypertension in neurogenic lung edema vagus nerve.
- Above we discussed axon damage. That is what happened in this study, the researchers (11) noted significant degenerated axon density of vagal nerves.
Vagus nerve degeneration causes Auerbach network (responsible for intestinal peristaltic movement) degeneration. The Auerbach plexus or myenteric plexus is a group of ganglia that run throughout the entire gastrointestinal tract and innervate its multiple layers of smooth muscle. (12)
- The research noted that ultimately intestinal gland atrophy resulted in 200 times more cell deaths and ulcers. One of the main findings again was axon damage along the gastric branches of the vagus nerve. (13)
The illustration above helps explain the wide-ranging symptoms and conditions of vagus nerve dysfunction along with the nerve network.
hallmark feature of dysautonomia
The most common symptoms of vagus nerve dysfunction include chronic pain, fatigue, dizziness, lightheadedness, spinning or pulling sensation (in a particular direction), weight loss, poor focusing, exercise intolerance, emotional lability, inflammation, heartburn, bloating, diarrhea, tinnitus, headache, anxiety, depression, brain fog, swallowing difficulty, vision changes, and inability to handle stress well.
One clue that there is a neck cause to a person’s dysautonomia is when turning of the head or facial movements such as laughing, chewing, or speaking cause what we term “episymptoms,” which are symptoms that are manifested by activities that don’t normally cause those symptoms, such as flushing, sweating, temperature dysregulation, headaches, vision changes, electric shocks, palpitations, tachycardia, or other autonomic symptoms.
Signs include changes in blood pressure, impaired thermoregulation, fatigue, changes in mental state (such as an increase in stress or lightheadedness), dilated pupils, uvula deviation to one side, and an inability of the palate to rise normally, decreased gag reflex, and dilated pupils. Many of these symptoms are signs of vagopathy.
In the image below, right vagopathy is evidenced by the lack of palatal elevation on the right side when saying “Ahhh.” This is caused by weakness in this patient’s right levantor veli palatini muscle which is innervated by the right vagus nerve.
Dysautonomia and cervical instability caused by ligament damage or weakness are progressive disorders. As vagal nerve function struggles, the autonomic nervous system’s (ANS) ability to regulate the body gets more compromised. Eventually, when it can no longer maintain blood pressure, orthostasis occurs (loss in blood pressure when standing), and ultimately multisystem atrophy that can include all the internal organs, in what is termed “pure autonomic failure.” When a person with cervical instability caused by ligament damage experiences symptoms that occur suddenly or increase in severity, it is often because they are starting to have autonomic collapse.
treatments: vagus nerve stimulation
Vagus nerve stimulation is an umbrella term to describe any medical technique, electrical stimulation, manual manipulation, self-help technique, or health regiment that stimulates the vagus nerve.
In June 2022 a paper in the journal Biological Psychology (14) discusses the “recently proposed role of the vagus nerve in limiting inflammation. This has led to the adoption of an earlier developed technique for epilepsy treatment, i.e., electrical stimulation of one vagus nerve bundle in the neck, but now for immune diseases like rheumatoid arthritis and the scope is even widening to depression and cluster headache. However, the problem in the application of whole vagus nerve stimulation is the lack of specificity: there is no way to titrate the stimulation to an observable effect variable. All nerves in the bundle, incoming and outgoing, can be ‘hit’, leading to side-effects which limit the intended application.”
In July 2022, researchers in Italy wrote in the Journal of Electroconvulsive Therapy (15) that vagus nerve stimulation can be effective for treatment-resistant depression. In this study, five patients treated with implanted with electronic vagus nerve stimulation were followed for 6 to 12 years after implantation.
The VNS implant was associated with a sustained response (more than 10 years) in terms of clinical response and social, occupational, and psychological functioning in 3 patients. Two patients dropped out after 6 and 7 years of treatment, respectively. Vagus nerve stimulation was well tolerated by all patients, who reported only mild adverse effects.
self-help for the vagus nerve
massage
Gentle massage is a common method of vagus nerve stimulation. “Massage behind the ear since a branch of the vagus nerve actually travels near that area,” Kessler advises. “Additionally, gently tugging down on the ear also stimulates the vagus nerve.”
Psychiatrist Sam Zand, founder of the Anywhere Clinic, also suggests doing vagus nerve massage on the side of the neck where you can feel the pulse of your carotid artery pulse. “This can improve vagal tone and instantly calm down an increased heart rate and panicky feelings,” he tells DailyOM. Press gently, circling the space under the angle of your jaw anytime you’re feeling anxious, he suggests. You can do this exercise for 5 to 10 minutes, but stop if you start feeling lightheaded or dizzy.
vagus nerve tapping
Another common way to stimulate your vagus nerve is through tapping. Juliano-Villani suggests gently drumming your thymus point, or the midpoint of your chest. “This is known as the ‘happiness point,’” she says. “You can tap here with your pointer and index fingers for about 20 seconds, or longer if it feels good, while focusing on your breath. Notice what happens. For me, I get more energized and focused.”
deep breathing
Juliano-Villani also suggests incorporating deep breathing into your daily routine to stay regulated. “Most of us are shallow breathers, so practice taking deep belly breaths and exhaling longer than you inhale,” she says. “If you suffer from anxiety and panic attacks, this is also important to integrate into your toolbox.”
humming, singing, or gargling
Golden advises her patients to do one of these three things before eating a meal to get their bodies ready for digestion. “This can help reduce uncomfortable symptoms like bloating, stomach pain, cramping, and acid reflux after eating, and it can even help improve appetite in people struggling to eat enough,” she explains.
progressive muscle relaxation
This biofeedback exercise involves tensing and then releasing each muscle group or area of the body for a few seconds and then moving to the next, starting at one end (like the face) and ending at the other (the feet). “It allows us to combine somatic mindfulness, relaxation breathing, and muscle tension relief to enhance the parasympathetic nervous drive,” Zand explains. You can do this exercise once daily, though Zand says that ideally you would build up to doing it three times a day for optimal results.
exercise
Finally, simple exercise can increase vagal nerve activity, Kessler says, particularly endurance and interval training. Any way that you’re able to move your body, though, can make a positive impact.
_____________
This blog is Part 3 of an edited article originally published by Caring Medical Regenerative Medicine Center.
“Self help for the vagus nerve” was written by Natasha Burton, a freelance writer and author with https://www.dailyom.com/
About the author: Ross Hauser MD. Medical Director, Caring Medical Regenerative Medicine Center, Fort Myers, Florida, USA
Board Certified Physiatrist (or Physical Medicine and Rehabilitation Specialist): completed residency training in Physical Medicine and Rehabilitation at Loyola Medical Center in Chicago; MD University of Illinois, Chicago; and Bachelor of Science undergraduate degree from the University of Illinois, Urbana-Champaign.
References:
1 Syamsunder AN, Pal GK, Pal P, Kamalanathan CS, Parija SC, Nanda N. Association of sympathovagal imbalance with cardiovascular risks in overt hypothyroidism. North American Journal of Medical Sciences. 2013 Sep;5(9):554. [Google Scholar]
2 Tankeu AT, Azabji-Kenfack M, Nganou CN, Ngassam E, Kuate-Mfeukeu L, Mba C, Dehayem MY, Mbanya JC, Sobngwi E. Effect of propranolol on heart rate variability in hyperthyroidism. BMC Research Notes. 2018 Dec;11(1):1-4. [Google Scholar]
3 De Couck M, Mravec B, Gidron Y. You may need the vagus nerve to understand pathophysiology and to treat diseases. Clinical science. 2012 Apr 1;122(7):323-8. [Google Scholar]
4. Mol MB, Strous MT, van Osch FH, Vogelaar FJ, Barten DG, Farchi M, Foudraine NA, Gidron Y. Heart-rate-variability (HRV), predicts outcomes in COVID-19. PLoS One. 2021 Oct 28;16(10):e0258841. [Google Scholar].
5 Diener HC, Gaul C, Holle-Lee D, Jürgens TP, Kraya T, Kurth T, Nägel S, Neeb L, Straube A. Headache-an Update 2018. Laryngo-Rhino-Otologie. 2019 Mar 7;98(3):192-217. [Google Scholar]
6 Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E, Mertens P. Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta neurochirurgica. 2011 Dec;153(12):2365-75. [Google Scholar]
7 Taher F, Bokums K, Aichmair A, Hughes AP. C1–C2 instability with severe occipital headache in the setting of vertebral artery facet complex erosion. European Spine Journal. 2014 May;23(2):145-9. [Google Scholar]
8 Sleigh JN, Rossor AM, Fellows AD, Tosolini AP, Schiavo G. Axonal transport and neurological disease. Nature Reviews Neurology. 2019 Dec;15(12):691-703. [Google Scholar]
9 Yolas C, Kanat A, Aydin MD. Unraveling of the effect of nodose ganglion degeneration on the coronary artery vasospasm after subarachnoid hemorrhage: an experimental study. World Neurosurg. 2016 Feb;86:79-87 [Google Scholar]
10 Atalay C, Gundogdu B, Aydin MD. Vagal ischemia induced lung immune component infarct following subarachnoid hemorrhage: an experimental study. Turk Neurosurg. 2017 Jan 1;27(4):509-15. [Google Scholar]
11 Soyalp C, Kocak MN, Ahiskalioglu A, Aksoy M, Atalay C, Aydin MD, Cakir M, Calikoglu C, Ozmen S. New determinants for casual peripheral mechanism of neurogenic lung edema in subarachnoid hemorrhage due to ischemic degeneration of vagal nerve, kidney and lung circuitry. Experimental study. Acta Cirúrgica Brasileira. 2019 Mar 18;34. [Google Scholar]
12 Shahrestani J, Das JM. Neuroanatomy, auerbach plexus. StatPearls [Internet]. 2021 Jun 4. [Google Scholar]
13 Cakir M, Ahiskalioglu A, Karadeniz E, Aydin MD, Malcok UA, Soyalp C, Calikoglu C, Sengul G, Sipal S, Yayik AM. A new described mechanisms of intestinal glandular atrophy induced by vagal nerve/Auerbach network degeneration following subarachnoid hemorrhage: The first experimental study. Journal of Clinical Neuroscience. 2019 Jan 1;59:305-9. [Google Scholar]
14 Karemaker JM. The multibranched nerve: vagal function beyond heart rate variability. Biological Psychology. 2022 Jun 7:108378. [Google Scholar]
15 Pigato G, Rosson S, Bresolin N, Toffanin T, Sambataro F, Olivo D, Perini G, Causin F, Denaro L, Landi A, D’Avella D. Vagus Nerve Stimulation in Treatment-Resistant Depression: A Case Series of Long-Term Follow-up. The Journal of ECT.:10-97. [Google Scholar]
Neurosoma 