Therapeutic Observation of Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Migraine in Pediatric Patients: A Case Report

Siqi WENG¹Yao Xue²Xue-Zhen XIAO³Berthold Hocher²Yishui Zhang¹Xiaowei Yang¹Qirui Liu¹Yabin Ji^1*

• ¹Southern Medical University Nanfang Hospital Department of Neurology, Guangzhou, China
• ²Fifth Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany, Heidelberg, Germany
• ³Zhuhai Fudan Innovation Research Institute, Zhuhai, China

Background: Although interest in migraine has increased in recent years, important gaps remain in understanding and optimizing its management. These gaps are particularly pronounced in pediatric migraine, which continues to be under-studied. Case report: This case report demonstrates the efficacy and safety of transcutaneous auricular vagus nerve stimulation (taVNS) in an 8-year-old male with refractory chronic migraine with aura (2–3 weekly episodes; VAS 5-9; duration of each episode was 24 hours). After discontinuing all prophylactic and abortive medications (except ibuprofen suspension like Motrin), the patient underwent a 28-week taVNS protocol: 4-week acute intervention, 4-week intermission period, 12-week preventive intervention, and 8-week follow-up. During the acute intervention phase, headache duration decreased by 84.4%, and frequency was reduced to fewer than 2 episodes/week, with complete aura resolution. The preventive intervention yielded further improvement to fewer than 1 episode/week by week 8 (with a 37.5% reduction in medication use). At final follow-up, the patient maintained a medication-free status with only 3 mild episodes (VAS 1–3; duration <30 minutes) in the last 4 weeks. No adverse events were observed. Conclusion: TaVNS was effective and safe in the management of chronic migraine in the reported pediatric patient. These findings suggest the need for further evaluation of this non-pharmacological intervention in pediatric migraine.