[ HEAD-TO-HEAD ]

gammaCore Sapphire CV vs Truvaga 350 vs Pulsetto (2026)

gammaCore Sapphire CV, Truvaga 350 and Pulsetto are the three cervical tVNS devices users compare across the regulated–consumer spectrum. gammaCore is FDA-cleared prescription only; Truvaga is its consumer over-the-counter sibling on the same hardware platform; Pulsetto is the most accessible consumer collar with the broadest protocol library. Three regulatory tiers, one nerve target.

VERDICT: TIE

Different tiers. gammaCore for clinically-indicated headache patients with a prescriber. Truvaga 350 for consumers wanting the gammaCore platform without prescription. Pulsetto for the most accessible daily-use cervical tVNS.

electroCore8.4 / 10

gammaCore Sapphire CV

Prescription cervical tVNS (handheld)

The FDA-cleared medical reference for non-invasive cervical VNS — a clinical tool, not a consumer wellness device.

electroCore7.7 / 10

Truvaga 350

Consumer cervical tVNS (handheld)

gammaCore’s clinical hardware repackaged as a consumer wellness device — strong provenance, modest evidence in the wellness indication.

Pulsetto7.4 / 10

Pulsetto

Consumer cervical tVNS (neck collar)

The most accessible consumer tVNS device — strong on protocol variety and price, lighter on independent clinical evidence.

Head-to-head breakdown

FDA clearance
gammaCore: FDA-cleared for migraine and cluster headache. Truvaga and Pulsetto: consumer wellness devices, not FDA-cleared. gammaCore is the only clinically-authorised non-invasive VNS in the US.
gammaCore Sapphire CV
Trial evidence — within indication
gammaCore: 30+ randomised trials for migraine and cluster headache. Truvaga: inherits gammaCore platform safety. Pulsetto: one pilot plus company-sponsored studies.
gammaCore Sapphire CV
Hardware platform
gammaCore and Truvaga share the same electroCore hardware platform (5 kHz burst waveform). Pulsetto is a different design (consumer collar with neck pads).
gammaCore Sapphire CV
Form factor
Pulsetto: lightweight neck collar, wear-and-go. gammaCore and Truvaga: handheld, requires active holding to the side of the neck.
Pulsetto
Protocol variety
Pulsetto: four guided programmes. Truvaga: intensity adjustment within fixed 2-minute sessions. gammaCore: dose set by prescriber, no user variation.
Pulsetto
Session lifetime
Pulsetto: unlimited sessions for device lifetime. Truvaga 350: 350-session cap then retirement. gammaCore: refill-card model.
Pulsetto
Consumer accessibility
Pulsetto: lowest barrier — direct consumer purchase, no prescription. Truvaga: OTC, slightly more involved. gammaCore: prescription required.
Pulsetto
Price
Pulsetto: $269. Truvaga 350: $499 + refill model. gammaCore: ~$600+ with refill cards plus insurance coverage variation.
Pulsetto

Choose gammaCore Sapphire CV

Choose gammaCore Sapphire CV if you have a diagnosed migraine or cluster-headache condition and a prescriber willing to write for it — the only FDA-cleared non-invasive VNS device.

Choose Truvaga 350

Choose Truvaga 350 if you want the gammaCore hardware platform without the prescription gate — same 5 kHz cervical waveform, sold over-the-counter as a wellness device.

Choose Pulsetto

Choose Pulsetto if you want the most accessible consumer cervical tVNS — neck collar with four guided programmes (sleep, stress, anxiety, pain) at the lowest price.

The short version

Three regulatory tiers on the same vagal-trunk target. gammaCore for clinical headache patients; Truvaga for consumers wanting the gammaCore platform without prescription; Pulsetto for the most accessible consumer cervical tVNS at the lowest price.

When gammaCore Sapphire CV is the right pick

If you have a diagnosed migraine or cluster-headache condition and a prescriber willing to write for it, gammaCore is the right tool. The FDA clearance and 30+ randomised trials are the regulatory value. Wrong shape for general wellness.

When Truvaga 350 is the right pick

If you want the gammaCore hardware platform — same 5 kHz cervical waveform, same manufacturing pedigree — without going through a clinician, Truvaga is the right shape. The wellness indication is consumer-direct; the clinical evidence is for the platform, not Truvaga’s labelling.

When Pulsetto is the right pick

If you want a daily-use cervical tVNS collar with four guided programmes and no clinical commitment, Pulsetto is the right shape. The lowest price, the broadest protocol library, and the no-cap session lifetime are the differentiators. Most consumer users land here.

Common questions

Which cervical tVNS device is best — gammaCore, Truvaga or Pulsetto?

Depends on what you want. gammaCore for clinically-indicated headache treatment with prescriber support. Truvaga for the gammaCore platform without the prescription gate. Pulsetto for the most accessible consumer cervical tVNS at the lowest price with the broadest protocol library.

Are Truvaga and gammaCore really the same hardware?

Same platform — both made by electroCore, both using the 5 kHz cervical burst waveform. The clinical labelling differs: gammaCore is FDA-cleared for migraine and cluster headache, Truvaga is sold over-the-counter as a wellness device.

Is Pulsetto FDA-cleared?

No. Pulsetto is CE-marked in Europe as a consumer wellness device and sold OTC in the US. The only FDA-cleared non-invasive cervical VNS device is gammaCore, which is prescription-only.

Which has the strongest acute effect?

Roughly comparable across the three at peak intensity — all target the cervical vagal trunk. gammaCore and Truvaga deliver focused 2-minute high-intensity sessions; Pulsetto delivers longer, gentler 4–20 minute sessions. Different temporal shapes; comparable cumulative dose.

Can Truvaga replace gammaCore for migraines?

Not clinically — Truvaga is not FDA-cleared for any indication. Users with a clinical migraine or cluster diagnosis should use gammaCore under medical guidance. Truvaga is sold as a general wellness device, not a headache treatment.

See the full ranking

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