{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:06:43Z","timestamp":1784326003749,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T00:00:00Z","timestamp":1543536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["SFB936\/A5"],"award-info":[{"award-number":["SFB936\/A5"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The trigeminal autonomic reflex plays an important role in primary headache syndromes. Noninvasive vagal nerve stimulation (nVNS) may be an effective modulator of this reflex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010two healthy volunteers underwent kinetic oscillation stimulation (KOS) of the left nostril as a reliable trigger of the trigeminal autonomic reflex. Previous to KOS, left cervical nVNS, sham simulation, or no stimulation was applied. Lacrimation was quantified using the standardized Schirmer ll test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Treatment with cervical nVNS significantly reduced lacrimation between no stimulation and nVNS on the ipsilateral side (minute 5: <jats:italic>p<\/jats:italic> = 0.026, \u03b7<jats:italic>p<\/jats:italic><jats:sup>2<\/jats:sup> = 0.85, 95% confidence interval [CI] = 1.39\u201318.04; no stimulation: minute 5, 14.4 \u00b1 9.3 mm; nVNS: minute 5, 4.7 \u00b1 8.6 mm, mean \u00b1 standard deviation) as well as between sham stimulation and nVNS (minute 5: <jats:italic>p<\/jats:italic> = 0.030, \u03b7<jats:italic>p<\/jats:italic><jats:sup>2<\/jats:sup> = 0.85, 95% CI = 1.04\u201317.24; sham: minute 5, 13.9 \u00b1 6.4 mm). On the contralateral side, no significant increase between baseline and KOS was observed for nVNS (minute 5: <jats:italic>p<\/jats:italic> = 0.614, <jats:italic>d<\/jats:italic> = 0.12, 95% CI = \u22127.09 to 4.31; minute 5, 1.4 \u00b1 11.5 mm) compared to both sham stimulation (minute 5: <jats:italic>p<\/jats:italic> = 0.023, <jats:italic>d<\/jats:italic> = 0.57, 95% CI = \u221211.46 to \u22120.96; minute 5, 6.2 \u00b1 10.9 mm) and no stimulation (minute 5: <jats:italic>p<\/jats:italic> &lt; 0.030, <jats:italic>d<\/jats:italic> = 0.62, 95% CI = \u221213.45 to \u22120.81; minute 5, 7.1 \u00b1 11.4 mm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Cervical nVNS resulted in a robust bilateral reduction of provoked lacrimation. This effect could be mediated either by direct bilateral activation of structures such as the nucleus of the solitary tract or by a top\u2010down modulation via the hypothalamus. 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3499-1506","authenticated-orcid":false,"given":"Arne","family":"May","sequence":"additional","affiliation":[{"name":"Department of Systems Neuroscience University Medical Center Hamburg\u2010Eppendorf  Hamburg 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