Vagus nerve dysfunction is implicated in the pathophysiology of many different symptoms and diseases that plague humanity. In many cases, the etiology of this condition remains elusive. One potentially implicating factor is cervical spine pathology, as the 2 vagus nerves are located in the carotid sheath just anterior to the cervical vertebrae. We propose that cervicovagopathy occurs primarily by the slow stretching of the posterior cervical ligaments because of a forward head-facedown lifestyle from excessive cell phone and computer usage. While the excessive stretch and compression on the vagus nerve initially just inhibits electrical impulses (conduction block), the condition progresses to ligamentous cervical instability. It ultimately results in a breakdown of the cervical curve (dysstructure), leading to vagus neuron cell death (degeneration), which can be documented by carotid sheath ultrasound. Cervical structural, internal jugular vein, and vagus nerve cross-sectional area measurements are presented from a retrospective chart review of 234 consecutive patients with no obvious cause for 1 of 9 specific symptoms-anxiety, dizziness, fatigue, irritability, lightheadedness, insomnia, sleeping difficulty, neck pain, and neck cracking/popping. Those cases of vagus nerve degeneration from a structural cause require corrective cervical structural therapies such as proper ergonomics, physiotherapy, cervical curve and postural exercises, low-force adjustments, and prolotherapy. A case example is given to demonstrate how cervical structural treatments can open up internal jugular veins and improve a patient's chronic symptoms. Resolution of symptoms that occur alongside improvements in vagus nerve cross-sectional areas (regeneration), correlating with restoration of the cervical lordotic curve and stability, will prove this hypothesis. pmc Front Neurol Front Neurol 1401 frontneurology Front. Neurol. Frontiers in Neurology 1664-2295 Frontiers Media SA PMC12263383 PMC12263383.1 12263383 12263383 40672458 10.3389/fneur.2025.1572863 1 Neurology Hypothesis and Theory Cervicovagopathy: ligamentous cervical instability and dysstructure as a potential etiology for vagus nerve dysfunction in the cause of human symptoms and diseases Hauser Ross A. It ultimately results in a breakdown of the cervical curve (dysstructure), leading to vagus neuron cell death (degeneration), which can be documented by carotid sheath ultrasound. Cervical structural, internal jugular vein, and vagus nerve cross-sectional area measurements are presented from a retrospective chart review of 234 consecutive patients with no obvious cause for 1 of 9 specific symptoms—anxiety, dizziness, fatigue, irritability, lightheadedness, insomnia, sleeping difficulty, neck pain, and neck cracking/popping. Those cases of vagus nerve degeneration from a structural cause require corrective cervical structural therapies such as proper ergonomics, physiotherapy, cervical curve and postural The cause of vagal or parasympathetic dysfunction has many chemical and emotional etiologies, including diabetes, heavy metals, medications, and emotional or financial stress, but a cause that is overlooked is structural injury ( 5 ). As the list of symptoms and diseases continues to grow, including chronic pain, depression, tinnitus, migraine headache, seizures, heart failure, Alzheimer’s dementia, and systemic inflammation, it is prudent that clinicians and the patients they treat understand the VN anatomy, injury, and the potential pathophysiology it causes ( 6–8 ) (see Figure 2 ). Figure 2 A list of diseases/conditions/symptoms that potentially involve the vagus nerves. Stretch or other deformation injuries to the axons can cause loss of microtubules and neurofilaments, loss of axon transport, and the accumulation of toxic substances that can destroy either transport or the axon itself ( 53 ). The carotid sheath contents, including the VN, are highly vulnerable to tissue strain by deformations or deviations from the normal, stable cervical lordotic curve due to their location and length, as the vagus nerves run just anterior to the anterior vertebral bodies. Figure 7 Ligamentous upper cervical instability potential etiology of vagus nerve dysfunction. This dysfunction can occur even without mechanical pressure on the VN but by the presence of stressors, including chronic pain, which suppress vagus nerve activity ( 83 , 93 , 94 ). The most common symptoms of VN dysfunction (cervicovagopathy and dysautonomia) include chronic pain, fatigue, dizziness, lightheadedness, a 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. Progressive compression of the carotid sheath by ligamentous cervical instability may be at the forefront of VN degeneration and the symptoms it causes (see Figure 11 ). This connection would also explain the association between increased cerebral venous pressure, intracranial pressure, and dysautonomia ( 87 , 95 ). Figure 11 The potential symptoms from ligamentous cervical instability and the pathophysiology it causes, including vagus nerve degeneration and dysfunction. Flowchart illustrating the effects of trauma or a forward head-facedown lifestyle on the body. Disorders and diseases with a VN component may necessitate corrective cervical structural therapies. Dynamic structural medicine principles note that atlas misalignments, cervical dysstructure, and ligamentous cervical instability—especially at the atlanto-axis (C1–C2)—need to be resolved to decrease the destructive forces on the VN. Clinical relevance and future directions Our findings provide new insights into the potential structural causes of vagus nerve dysfunction and degeneration, and thus chronic autonomic dysfunction.

Major depressive disorder (MDD) is a major psychiatric condition associated with functional impairment and high levels of morbidity and mortality (M. Li, 2015) (Lohoff, 2010). It is characterized by mode alterations, diminished interests, impaired cognitive function and vegetative symptoms such as disturbed sleep and appetite changes (Christian Otte, 2016) are common patients suffering from MDD. Our nervous system is built around the balance and harmony of two opposing activities (Laurie Kelly McCorry, 2007). 1. The sympathetic nervous system (SNS) is associated with the fight or flight response. 2. The parasympathetic nervous system (PNS) is associated with relaxation, digestion, and regeneration. These two systems are meant to work in rhythmic alternation, a process that supports healthy rhythms of alertness and restfulness that facilitate physical and mental health (Shah, 2018). In order to treat ailments such as MDD, many techniques are used to stimulate the vagus nerve for better functioning (Bruno Bonaz, 2018). Different forms of pranayama tends to activate different branches of the autonomic nervous system, this causes positive changes to the oxygen consumption, metabolism and skin resistance. The literature evidence gathered states that the mechanisms of the vagul nerve stimulation helps in the parasympathetic activation in an event of stress depression and major depression. When the pranayam is mixed with certain yogic asana’s while controlling the breath, it seems t Different forms of pranayama tends to activate different branches of the autonomic nervous system, this causes positive changes to the oxygen consumption, metabolism and skin resistance. The literature evidence gathered states that the mechanisms of the vagul nerve stimulation helps in the parasympathetic activation in an event of stress depression and major depression. When the pranayam is mixed with certain yogic asana’s while controlling the breath, it seems to have a better countering of MDD and related disorders. KEY WORDS: Major Depressive Disorder, Pranayama, Parasympathetic Nervous System, Vagus Nerve, Yoga Asana. The vagus nerve represents a main component of the parasympathetic nervous syst em; it oversees a variety of crucial bodily functions, including control of mood, immune response, digestion, many involuntary actions and heart rate (Sigrid Breit, 2018). It establishes one of the most The gut brain connection is formally made by the vagus nerve. In order to treat ailments such as MDD, many techniques are used to stimulate the vagus nerve for better functioning (Bruno Bonaz, 2018); generally it lowers the stress levels and helps one feel well. Therefore a healthy vagus nerve helps in leadership and decision making during flight or fight response (Grant Soosalu, 2019). The function of the vagus nerve is impaired by stress, depression anxiety, poor life style and other factors such as smoking and drinking. NATURAL TECHNIQUES THAT HELP STIMULATE THE VAGUS NERVE. A small study of peop le with irritable bowel syndrome and mild -to-moderate anxiety or depression found that taking a probiotic called Bifidobacterium longumNCC3001 for six weeks significantly improved symptoms (Maria Ines Pinto -Sanchez, 2017) . Another study found that taking a prebiotic called galactooligosaccharides for three weeks significantly reduced the amount of stress hormone cortisol (Kristin Schmidt, 2015). Since the gut brain axis is coordinated largly by the v agus nerve, food items consisting of probiotics will the better functioning of the vagus nerve and the brain. Therefore we can assume vagus nerve gets all the positive impulses to balance the parasympathetic nervous system through physical exercise such as yoga asana practice. It helps to reduce the impact of depression on the mind . Research done on the effect of vagal stimulation showed that they reduce multiple physiological stress markers this includes: heart rate, blood pressure, cortisol levels and inflammatory bodies (M. C., 2017). Different forms of pranayama tends to activate different branches of the autonomic nervous system, this causes positive chang es to the oxygen consumption, metabolism and skin resistance. Novaes, 2020), which singles a chain reaction of the brain anatomy balancing itself during long term Pranayama sessions. Kapalbhati pranayama will induce a rapid fight or flight response and yogic breathing will induce parasympathetic activation which gives a good vagal tone. Bhramari pranayama will also induce a good vagal tone since it vibrates the vocal cords with the sound of the humming bee. Si nce the area of the neck is a vagal tone activation site, bhramari pranayama is an immensely a great technique to relive stress, depression and anxiety due to the fact that the pranayama helps to resonate at an ideal frequency for the stimulating of the vagus nerve . Slowing the flow can encourage a shif t from Fight or Flight mode to rest and digest mode, which is a hallmark of an optimally functioning vagus nerve. Shavasana has shown to be a relaxing pose that brings down the adrenaline and cortisol rush which gives an important relaxati on after yoga practices (Kishore Kumar Katuri, 2016). CONCLUSION The literature evidence gathered states that the mechanisms of the vagul nerve stimulation helps in the parasympathetic activ ation in an event of stress depression and major depression. Yoga and exercise for symptoms of depression and anxiety in people with poststroke disability: a randomized, controlled pilot trial. alternate health medicine , 34-43. 49. Wood, T. (2017, 12 27). tiffanywoodyoga.com/blog/meet-your-vagus-nerve. Retrieved 10 04, 2021, from tiffanywoodyoga: https://tiffanywoodyoga.com/blog/meet-your-vagus-nerve 50. Xiao Ma, Z.-Q. Y.-Q.-Y.-T.-X.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. fontiers in psychology . Cite this Article: Namal Bandara, Dr. Vijay kumar Singh (2021).

and parasympathetic, particularly the vagus nerve, (which innervates the heart), can be caused by anxiety and stress due to acute or chronic elevations Palpitations occur when a person becomes aware of their heartbeat. The heartbeat may feel hard, fast, or uneven in their chest. Symptoms include a very fast or irregular heartbeat. Palpitations are a sensory symptom. They are often described as a skipped beat, a rapid flutter, or a pounding in the chest or neck. Palpitations are not always the result of a physical problem with the heart and can be Anxiety and stress elevate the body's level of cortisol and adrenaline, which in turn can interfere with the normal functioning of the parasympathetic nervous system resulting in overstimulation of the vagus nerve. Vagus nerve induced palpitation is felt as a thud, a hollow fluttery sensation, or a skipped beat, depending on at what point during the heart's normal rhythm the vagus nerve fires. In many cases, the anxiety and panic of experiencing palpitations cause a patient to experience further anxiety and increased vagus nerve stimulation. The link between anxiety and palpitation may also explain why many panic attacks involve an impending sense of cardiac arrest. Similarly, physical and mental stress may contribute to the occurrence of palpitation, possibly due to the depletion of certain micronutrients involved in maintaining healthy psychological and physiological function. Gastrointestinal bloating, indigestion and hiccups have also been associated with overstimulation of the vagus nerve causing palpitations, due to branches of the vagus nerve innervating the GI tract, diaphragm, and lungs. Many psychiatric conditions can result in palpitations including depression, generalized anxiety disorder, panic attacks, and somatization. However one study noted that up to 67% of patients diagnosed with a mental health condition had an underlying arrhythmia. There are many metabolic conditions that can result in palpitations i Palpitations occur when a person becomes aware of their heartbeat. The heartbeat may feel hard, fast, or uneven in their chest. Symptoms include a very fast or irregular heartbeat. Palpitations are a sensory symptom. They are often described as a skipped beat, a rapid flutter, or a pounding in the chest or neck. Palpitations are not always the result of a physical problem with the heart and can be linked to anxiety. However, they may signal a fast or irregular heartbeat. Palpitations can be brief or long-lasting. They can be intermittent or continuous. Other symptoms can include dizziness, shortness of Extra-cardiac stimulation of the sympathetic nervous system (inappropriate stimulation of the sympathetic and parasympathetic, particularly the vagus nerve, (which innervates the heart), can be caused by anxiety and stress due to acute or chronic elevations in glucocorticoids and catecholamines. Gastrointestinal distress such as bloating or indigestion, along with muscular imbalances and poor posture, can also irritate the vagus nerve causing palpitations) Sympathetic overdrive (panic disorder, low blood sugar, hypoxia, antihistamines (levocetirizine), low red blood cell count, heart failure, mitral valve prolapse). Hyperdynamic circulation (valvular incompetence, thyrotoxicosis, hypercapnia, high body temperature, low red blood cell count, pregnancy). Abnormal heart rhythms (ectopic beat, premature atrial contraction, junctional escape beat, premature ventricular contraction, atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, heart block). Pectus Excavatum, also known as funnel chest, is a chest wall deformity. When the breastbone (sternum) and attached ribs are sunken in enough to put excess pressure on the heart and lungs which can cause tachycardia and skipped beats. Palpitations can occur during times of catecholamine excess, such as during exercise or at times of stress. The cause of the palpitations during these conditions is often a sustained supraventricular tachycardia or ventricular tachyarrhythmia. Supraventricular tachycardias can also be induced at the termination of exercise when the withdrawal of catecholamines is coupled with a surge in the vagal tone. Palpitations secondary to catecholamine excess may also occur during emotionally startling experiences, especially in patients with a long QT syndrome. Anxiety and stress elevate the body's level of cortisol and adrenaline, which in turn can interfere with the normal functioning of the parasympathetic nervous system resulting in overstimulation of the vagus nerve. Vagus nerve induced palpitation is felt as a thud, a hollow fluttery sensation, or a skipped beat, depending on at what point during the heart's normal rhythm the vagus nerve fires. In many cases, the anxiety and panic of experiencing palpitations cause a patient to experience further anxiety and increased vagus nerve stimulation. The link between anxiety and palpitation may also explain why many panic attacks involve an impending sense of cardiac arrest. Similarly, physical and mental stress may contribute to the occurrence of palpitation, possibly due to the depletion of certain micronutrients involved in maintaining healthy psychological and physiological function. Gastrointestinal bloating, indigestion and hiccups have also been associated with overstimulation of the vagus nerve causing palpitations, due to branches of the vagus nerve innervating the GI tract, diaphragm, and lungs. Many psychiatric conditions can result in palpitations including depression, generalized anxiety disorder, panic attacks, and somatization. However one study noted that up to 67% of patients diagnosed with a mental health condition had an underlying arrhythmia. There are many metabolic conditions that can result in palpitations including, hyperthyroidism, hypoglycemia, hypocalcemia, hyperkalemia, hypokalemia, hypermagnesemia, hypomagnesemia, and pheochromocytoma.