TMS is a non-invasive depression treatment whose common temporary effects include scalp discomfort and headache, with screening needed for medical risks and implants.
TMS Side Effects and Safety: A North Carolina Patient Guide
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate targeted areas of the brain. It is most commonly discussed for major depressive disorder, particularly when other treatments have not provided enough benefit or have caused difficult side effects.
TMS was cleared by the FDA for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. It does not involve surgery, anaesthesia or electrical current being passed through the body. During treatment, a clinician places a magnetic coil against the scalp while the patient remains awake and seated.
For many people, TMS is well tolerated. However, like any medical treatment, it can cause side effects and is not suitable for everyone. A proper assessment should include a discussion of your health history, medicines, previous treatments and any implanted devices or metal near the head.
The most common TMS side effects
The most commonly reported side effects are discomfort at the treatment site and headache. These are usually mild to moderate, particularly early in a course of treatment.
Scalp discomfort
During a session, the magnetic pulses can feel like tapping, knocking or tingling on the scalp. Some people describe a brief pulling sensation in the facial muscles near the treatment area. Discomfort may be more noticeable during the first few sessions while the treatment team is finding settings that are both effective and tolerable.
Scalp discomfort often improves as a person becomes accustomed to treatment. Your clinician may be able to adjust the coil position, pulse settings or how gradually the treatment intensity is increased. It is important to say something during the session if the sensations are painful rather than merely uncomfortable.
Headache
Headache is another common side effect. It may occur shortly after a session or later in the day. In many cases it is short-lived and can be managed with simple measures such as rest, fluids or an appropriate over-the-counter pain medicine, if this is safe for you.
Do not assume that any medicine is suitable simply because it is available without prescription. Ask your clinician or pharmacist if you are unsure, particularly if you take other medicines or have liver, kidney, stomach or bleeding problems.
Other temporary effects
Some people may experience fatigue, light-headedness, facial twitching during pulses, or temporary irritation around the scalp. TMS sessions can also feel mentally tiring, especially when they are fitted around work, caring responsibilities or travel.
A standard course is often about 36 weekday sessions over six to nine weeks. This means that even mild side effects can feel significant if they affect daily routines. Let the clinic know early if symptoms are interfering with driving, work, sleep or other responsibilities.
The rare risk of seizure
Seizure is a recognised but rare risk of TMS. Clinics use screening procedures and treatment protocols designed to reduce this risk. The treatment team should review factors that may make a seizure more likely before beginning treatment and should revisit these factors if your health or medicines change during the course.
Tell the clinician if you have ever had:
- A seizure or epilepsy diagnosis
- A significant head injury
- A stroke or other neurological condition
- A brain tumour, brain surgery or a condition affecting the brain
- Fainting episodes that have not been assessed
- Severe sleep deprivation or major changes in sleep
- Heavy alcohol use, alcohol withdrawal, or use of recreational drugs
- A recent illness that may affect your overall health
This does not automatically mean you cannot have TMS. It means the clinician needs enough information to decide whether treatment is appropriate and whether additional precautions are needed.
If you have a seizure during treatment, the clinic should respond according to its medical safety procedures. Ask before starting how the clinic handles urgent situations and what support is available if you feel unwell during a visit.
Metal, implants and other safety checks
TMS involves a strong magnetic field close to the head. Certain metal objects or implanted medical devices may make TMS unsuitable, or may require specialist review.
Tell your clinician about any metal in or near your head, including metal from an injury, surgery or dental procedure. This may include clips, plates, screws, implanted devices, shrapnel or fragments from metalwork. Dental fillings, braces and some dental implants may not prevent treatment, but they should still be disclosed.
You should also report implanted electronic devices, such as certain stimulators, pumps or hearing-related implants. Whether a device is compatible with TMS depends on its type, location and manufacturer guidance. Do not rely on general online advice about a device; the TMS provider should assess your individual situation.
A clinician may ask for records from your surgeon, dentist, neurologist or another specialist. This can feel inconvenient, but it is an important part of safe planning.
Medicines and substances to discuss
Bring an up-to-date list of all medicines, including prescriptions, over-the-counter products, vitamins, supplements and herbal remedies. Include medicines you take only occasionally.
Some medicines can affect seizure threshold or interact with other aspects of your care. Your TMS clinician needs to know about changes in dose, newly started medicines and medicines you have stopped. Do not stop antidepressants, anti-anxiety medicines, sleeping tablets or other prescribed treatment on your own in order to begin TMS.
Be open about alcohol, cannabis and other substance use. The purpose is not to judge you. It is to identify avoidable safety risks and ensure the treatment plan reflects your circumstances.
If you are pregnant, trying to become pregnant, have recently given birth or are breastfeeding, discuss this with the clinician. They can consider your mental health needs, medical history and available treatment options with you.
What to tell your TMS clinician
A thorough consultation is an opportunity to raise concerns, not simply complete paperwork. You may find it helpful to write down your questions in advance.
Important information to share includes:
- Your diagnosis, symptoms and how they affect day-to-day life
- Previous depression treatments, including therapy and medicines
- Any past seizure, head injury or neurological condition
- All medicines, supplements and recent medication changes
- Metal, implants, medical devices and previous head or neck surgery
- Alcohol, drug use and major changes in sleep
- Pregnancy, breastfeeding or family-planning considerations
- Whether you have problems travelling to frequent appointments
- Any concerns about pain, anxiety, hearing protection or feeling claustrophobic
You should also tell the team about side effects as they arise, even if they seem minor. A worsening headache, unusual symptoms, changes in mood, or a new medical diagnosis may affect how the team approaches future sessions.
Questions to ask before treatment starts
It is reasonable to ask a clinic how it will monitor safety throughout the course. Useful questions include:
- How will you decide whether TMS is appropriate for me?
- What side effects do you commonly see, and how are they managed?
- What should I do if I develop a headache or feel unwell after a session?
- Who should I contact outside my scheduled appointment time?
- What is the clinic’s procedure for a seizure or other urgent event?
- Will my existing mental health clinician or GP be involved in my care?
- What happens if I need to miss sessions because of illness or travel?
The answer should be clear and practical. You should understand who is responsible for your treatment and what to do if your circumstances change.
Getting help in North Carolina
TMS Therapy North Carolina lists 72 published clinics across the state, including listings in Raleigh, Greenville, Cary, Huntersville, Charlotte, Fayetteville, Winston-Salem, Wilmington, Durham, Wilson, Concord and Clayton. Use the directory’s clinic listings to compare local options, its insurance guide for information on carriers commonly seen in North Carolina, including Blue Cross NC, State Health Plan for Teachers and State Employees, UnitedHealthcare, Aetna, Cigna, NC Medicaid managed care plans, Medicare through Palmetto GBA and TRICARE East, and the contact page for further help.
This article is educational information, not medical advice.
This page is informational and is not medical advice.