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Scalp discomfort and headache are the side effects most people hear about with transcranial magnetic stimulation (TMS), and they are usually short-lived. Facial tingling or twitching, lightheadedness, nausea, fatigue, or sleep changes can also occur. Tell the clinician supervising your sessions about symptoms that are severe, persistent, worsening, or simply unusual for you. A seizure is uncommon but serious; sudden hearing changes, fainting, worsening depression, suicidal thoughts, or markedly elevated or agitated behavior require urgent clinical attention.
TMS is administered by a trained clinical team, often as repetitive TMS (rTMS). The device, coil position, pulse settings, treatment schedule, and your health history all affect both benefits and risks. This guide explains what is generally expected, what to report, and how to prepare; it does not replace instructions from your own treatment team or emergency services.
What TMS side effects are considered common?
During rTMS, a coil placed against the scalp delivers magnetic pulses to targeted areas of the brain. The clicking sound and repeated tapping can stimulate nearby scalp and facial muscles. That physical stimulation explains why discomfort near the coil, headache, or brief facial movement can occur even when treatment is otherwise proceeding normally.
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Mayo Clinic describes common effects as generally mild to moderate, improving shortly after a session and sometimes becoming less noticeable as treatment continues. Pennine Care NHS Foundation Trust likewise identifies discomfort where the coil rests as its most common side effect and notes that post-treatment headache, faintness, or dizziness can occur. A clinician can alter stimulation settings if symptoms are troublesome.
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Symptoms commonly reported in patient information
- Scalp discomfort, tenderness, or pain at the stimulation site.
- Headache, including a tension-type headache after treatment.
- Facial tingling, twitching, or spasms on the stimulated side.
- Lightheadedness, dizziness, or (less often) feeling faint.
These effects often settle soon after a session. A symptom that repeatedly interferes with daily activities, lasts longer than your clinic said to expect, or becomes more intense should be discussed rather than endured silently.
How often do these effects occur?
A 2024 consensus update from the National Network of Depression Centers, Clinical TMS Society, and International Federation of Clinical Neurophysiology summarized rates across studies. The figures below describe groups in those studies; they are ranges or study estimates, not a prediction of your personal likelihood. Protocols, devices, definitions, and reporting methods differ.
| Reported effect | Study summary | How to interpret it |
|---|---|---|
| Significant scalp or stimulation-site pain/discomfort | 39% | A pooled professional-consensus estimate; severity and duration vary. |
| Tension-type headache | 28–65% | A broad range reflecting differences among studies and protocols. |
| Nausea | 7–11% | Not everyone with nausea needs to stop treatment; tell the team if it persists. |
| Dizziness or lightheadedness | 4–9% | May occur during or shortly after a session. |
| Fatigue | 7–8% | Track timing so the clinician can distinguish treatment effects from other causes. |
| Insomnia | 5–7% | Report a new or worsening sleep problem, especially with mood changes. |
The indexed consensus figures are the most recent professional summary identified for these rates, but the full-text source was not available for independent review in the source record. Use them as context, not as a guarantee for any particular device or treatment plan.
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Is a headache after TMS normal?
A mild headache during or soon after a session is a recognized effect. It may result from scalp-muscle stimulation, the pressure of the coil, or the intensity of the pulses. Clinics commonly observe whether the headache fades between sessions. Mayo Clinic says a provider may adjust stimulation or discuss an over-the-counter pain medicine; do not start, stop, or choose a medicine without checking what is appropriate for you, particularly if you take other medicines, are pregnant, or have another medical condition.
When a headache needs a call
Contact the prescribing or supervising clinician if headaches are severe, happen after most sessions, are becoming more frequent, trigger migraine, or do not settle in the time your clinic described. Mayo notes that frequent headache or migraine can be triggered and that treatment may need to stop. A sudden, unusually severe headache, headache with neurological symptoms, or headache after a collapse warrants urgent assessment rather than waiting for the next appointment.
Rare but serious risks
Seizure
TMS can provoke a seizure, but this is uncommon. A seizure during treatment requires the clinic’s immediate response and medical assessment. Tell the team before treatment about any personal or family seizure history, prior brain injury, stroke, brain tumor, or medicines and supplements that may affect seizure threshold. Do not conceal a previous seizure because a protocol appears low risk; the clinician must evaluate your specific circumstances.
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Hearing injury
The magnetic pulses produce loud clicking. FDA Class II Special Controls guidance states: Patients and those operating the device should always wear earplugs or similar hearing protection devices with a rating of 30dB of noise reduction during rTMS treatment.
Your clinic should provide or approve the protection and show you how to wear it. A sudden change in hearing, ringing that is new or markedly worse, ear pain, or difficulty tolerating the sound should be reported immediately. Do not substitute self-selected protection for the clinic’s device-specific instructions.
Mania, hypomania, and unusual behavior
Mood can change during treatment. New or escalating unusually elevated or irritable mood, much less need for sleep, racing thoughts, impulsive behavior, severe agitation, or other behavior that is out of character may indicate hypomania or mania and should be reported promptly. This is especially important for people with bipolar disorder or a history of mood elevation.
Worsening depression or suicidal thinking
FDA labeling guidance calls for monitoring worsening depression, suicidality, and unusual behavior during rTMS. Tell the treatment team promptly if depression is worsening, suicidal thoughts are new or stronger, or you feel less able to control your actions. If you may act on suicidal thoughts, cannot stay safe, or someone is in immediate danger, call your local emergency number or crisis service now and do not remain alone while waiting for help.
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When should you contact your TMS clinician?
Use the clinic’s after-session number or patient portal for symptoms that are not emergencies. Contact the team promptly for:
- Pain or headache that is persistent, significant, worsening, or repeatedly disrupting normal activities.
- New dizziness, faintness, nausea, fatigue, insomnia, or facial movements that do not improve as expected.
- A migraine pattern, frequent headaches, or any symptom that makes you question whether the next session is safe.
- New or worsening suicidal thoughts, marked agitation, unusually elevated or irritable mood, reduced need for sleep, or other unusual behavior.
- A seizure-like episode, fainting, sudden hearing change, or concern that hearing protection failed; the urgency depends on severity, so ask for immediate instructions or seek urgent assessment.
Do not wait for a routine review when a symptom is rapidly escalating. The FDA guidance advises close observation for mood and behavior changes and consideration of stopping rTMS if worsening continues. The 2024 professional consensus also emphasizes regular clinician visits to monitor suicidal ideation, emergent hypomania or mania, adverse effects, and overall clinical status.
What to tell the clinic before your first session
Risk screening is individualized. A condition on this list is not automatically a reason that every TMS protocol is unsafe, but the team needs the details to evaluate the device and settings.
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- List every medicine and supplement. Include prescription and nonprescription products, doses, recent changes, and substances that affect sleep or alertness.
- Describe seizure-related history. Tell the clinician about personal or family seizures, fainting episodes that were never explained, and any neurological diagnosis.
- Discuss mental-health history. Include bipolar disorder, psychosis, substance-related concerns, previous mania or hypomania, and current or recent suicidal thoughts.
- Report brain and headache conditions. Mention a brain tumor, stroke, traumatic brain injury, frequent or severe headaches, migraine, or other neurological illness.
- Identify metal or implanted devices. Give the exact device name and location for implants, stimulators, pumps, clips, or other metal. FDA guidance specifically warns that implanted stimulators in or near the head and magnetic fields can affect devices. The treating clinician must determine compatibility.
- Tell the team about pregnancy or plans to become pregnant and any other significant medical condition.
Bring an up-to-date medication and implant list if you are unsure of a device’s model. Never assume that a device is compatible because it is small, old, or outside the head; the clinic needs to verify it against the exact TMS system.
How to make sessions easier to monitor
Before the appointment
- Eat, hydrate, and sleep according to your clinician’s instructions; do not change prescribed medicines or caffeine use without asking.
- Wear the hearing protection supplied or approved by the clinic and tell staff if it does not seal comfortably.
- Tell staff about a headache, poor sleep, illness, medication change, or unusual mood before stimulation begins.
During stimulation
- Describe scalp pain, facial twitching, dizziness, or anxiety as soon as it becomes difficult to tolerate.
- Follow the operator’s instructions about posture, stopping signals, and hearing protection.
- Do not remove protection or reposition the coil yourself unless instructed.
After stimulation
Record when a symptom began, its severity, how long it lasted, and whether it affected work, driving, sleep, or safety. A simple log helps the clinician decide whether to adjust intensity, coil placement, schedule, or the treatment plan. Ask whether you should have someone accompany you if you have previously felt faint; the clinic’s advice takes priority over a generic rule.
Why side-effect rates differ between TMS protocols
There is no single “TMS side-effect rate” that applies to every treatment. Risk estimates depend on the treatment device and coil, pulse frequency and intensity, target location, session duration, number of sessions, and the person receiving treatment. A rate reported for one depression protocol should not be presented as the rate for every rTMS, theta-burst, or other magnetic-stimulation schedule.
| Factor | Why it matters |
|---|---|
| Device and coil design | Changes the shape and distribution of the magnetic field and the sound produced. |
| Pulse protocol | Frequency, intensity, train length, and pauses influence muscle stimulation and tolerability. |
| Target and positioning | A coil closer to sensitive scalp or facial muscles may feel different from another placement. |
| Personal history | Headache disorders, neurological conditions, medicines, sleep, and mood history alter risk assessment. |
| Clinic monitoring | Screening, hearing protection, emergency procedures, and follow-up determine how quickly problems are recognized. |
Ask your clinic which protocol and device you are receiving, what symptoms it expects, and exactly whom to call outside appointment hours. Those answers are more useful than applying a percentage from a different study to your own treatment.
What to do if you are unsure after a session
For a mild symptom that is already improving, follow the written after-care plan and mention it at the next visit. For a symptom that is persistent, worsening, or significant, contact the supervising clinician before the next session. For a seizure, loss of consciousness, sudden hearing change, immediate danger from suicidal thoughts, or rapidly escalating abnormal behavior, seek urgent help rather than relying on routine messaging.
TMS is not a do-it-yourself treatment. Keep the clinic informed, use the required hearing protection, and let the team decide whether a setting change, symptom treatment, pause, or discontinuation is appropriate.
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