TMS is a non-invasive depression treatment with usually mild, temporary effects such as scalp discomfort, headache, fatigue or light-headedness, requiring screening and reporting concerning symptoms.
TMS Side Effects and Safety: A New Hampshire 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 considered for major depressive disorder, particularly when other treatments have not provided enough benefit or have caused difficult side effects.
TMS does not involve surgery, anaesthesia or electrical current passing through the body. During treatment, a clinician places a magnetic coil against the scalp while you remain awake and seated. A standard course commonly involves weekday appointments over around six to nine weeks, often totalling about 36 sessions.
Like any medical treatment, TMS has possible side effects and safety considerations. A proper assessment before treatment is important, especially if you have a history of seizures, certain implanted devices, or other health conditions.
Common side effects
Most people who have TMS report mild and temporary side effects, particularly during the first few sessions. The two most common are scalp discomfort and headache.
Scalp discomfort
The tapping sensation from the magnetic pulses can feel unusual at first. Some people describe a knocking, tingling or brief tightening feeling on the scalp or around the forehead. The muscles of the face or jaw may twitch slightly during a session.
Discomfort is usually strongest when treatment begins and may reduce as you become used to it. The treatment team can often make adjustments to improve comfort, such as changing the coil position slightly or reviewing the stimulation setting. It is important to say something during the appointment rather than trying to tolerate significant pain.
Headache
A mild headache can occur during or after a treatment session. This is generally short-lived and may become less likely over the course of treatment. Your clinician can advise whether your usual headache medicine is suitable for you.
Headaches that are severe, persist, or feel different from your usual headaches should be reported to the treatment provider promptly. This is particularly important if they occur alongside other symptoms such as confusion, weakness, changes in vision or fainting.
Other possible short-term effects
Some people feel tired after a session, while others do not notice any change in energy. Mild light-headedness can occur, especially when standing up quickly after treatment. Taking a moment before leaving the chair and staying well hydrated may help.
TMS can also be noisy. The coil makes repeated clicking sounds during treatment, so ear protection is normally used. Tell the clinician if you have hearing difficulties, ear pain or a condition affecting your ears, as this may affect the precautions needed.
Mood and sleep can change during treatment. For many people, these changes are part of the underlying depression or anxiety rather than a direct side effect of TMS. However, it is still important to report worsening depression, agitation, unusual energy, reduced need for sleep, impulsive behaviour or thoughts of self-harm. These symptoms need clinical review regardless of their cause.
The rare risk of seizure
Seizure is the most serious recognised risk associated with TMS, but it is rare when treatment is provided using established safety procedures and appropriate screening.
A seizure is a sudden burst of abnormal electrical activity in the brain. It can cause involuntary movements, loss of awareness or confusion afterwards. TMS clinics are expected to have safety procedures and trained staff in place to respond if this occurs.
Your individual seizure risk matters. The clinician may ask about:
- Any previous seizure, epilepsy diagnosis or unexplained blackout
- Head injury, stroke, brain tumour or other neurological condition
- A family history of seizures
- Alcohol or drug use, including recent withdrawal
- Severe sleep deprivation
- Medicines that may lower the seizure threshold
- Major recent changes to prescription or non-prescription medicines
Do not stop prescribed medicines on your own before starting TMS. Instead, give the treatment team a complete and up-to-date list so they can decide whether anything needs to be reviewed with your prescribing clinician.
When TMS may not be suitable
TMS is not suitable for everyone. The main concern is usually metal or an electronic device in or close to the head, because the magnetic field could interact with it.
You should tell the clinician if you have, or may have:
- A cochlear implant or other implanted hearing device
- Brain stimulation equipment or electrodes
- An implanted device in the head or neck
- Clips, coils, stents, plates, screws or fragments of metal in or near the head
- A history of surgery to the head, brain, ears or neck
- Any injury involving metal fragments, including workplace or military injuries
Some dental work, braces and implants may not prevent treatment, but they should still be discussed. The clinic needs to know what the item is, where it is located and, if possible, what material it is made from.
Not all implanted medical devices automatically rule out TMS. However, their location and type need careful assessment. A treatment provider may need more information from your surgeon, dentist, neurologist or other specialist before deciding whether treatment can proceed safely.
What to tell your TMS clinician
The screening appointment is your opportunity to raise anything that could affect safety, comfort or treatment planning. Bring a written list if that makes it easier.
Tell the clinician about your mental health history, including depression, anxiety, bipolar disorder, psychosis, self-harm, hospital admissions and previous treatments. Mention if you have ever experienced periods of unusually elevated mood, racing thoughts, risky behaviour or very little need for sleep.
You should also discuss:
- All prescription medicines, over-the-counter medicines, vitamins and supplements
- Any recent medication changes
- Alcohol, cannabis or other substance use
- Sleep problems or recent severe lack of sleep
- Pregnancy, plans for pregnancy or breastfeeding
- Neurological conditions, migraines or frequent fainting
- Heart conditions and implanted medical equipment
- Hearing problems or sensitivity to sound
- Allergies and significant medical conditions
It is helpful to let the clinic know if you are unwell on the day of an appointment. A fever, acute illness, lack of sleep, heavy alcohol use or a substantial change in medication may mean the clinician wants to reassess before treatment goes ahead.
Questions to ask before starting
A New Hampshire TMS provider should explain the expected treatment schedule, how they monitor side effects and who to contact between appointments. You may wish to ask:
- How will my suitability and seizure risk be assessed?
- What side effects should I expect in the first week?
- What should I do if I get a headache or scalp discomfort?
- What symptoms mean I should contact the clinic urgently?
- Will my medicines be reviewed during the course?
- How will progress in my depression or anxiety symptoms be monitored?
- What happens if I miss a session because of illness, weather or travel?
New Hampshire weather and travel conditions can occasionally make weekday appointments difficult. If you are considering treatment, ask the clinic how missed sessions are handled and whether there is a clear contact process for cancellations.
Insurance and practical planning in New Hampshire
Coverage for TMS can vary according to your diagnosis, treatment history, plan rules and whether the clinic is in your insurance network. Carriers commonly seen in New Hampshire include Anthem Blue Cross Blue Shield New Hampshire, Harvard Pilgrim Health Care, Cigna, Aetna, UnitedHealthcare, NH Medicaid (Medicaid Care Management), Medicare including Advantage plans, and TRICARE East.
Before beginning treatment, check with both the clinic and your insurer. Ask whether prior authorisation is required, what records may be needed, and what your likely out-of-pocket costs could be. The clinic may be able to explain its own billing process, but your insurer remains the best source for confirmation of benefits.
Getting help in New Hampshire
TMS Therapy New Hampshire lists 29 published clinics across the state, including options in Manchester, Derry, Nashua, Salem, Dover, Portsmouth, Londonderry, Bedford, Peterborough, Concord and Exeter. Use the directory’s clinic listings to compare local options, read the insurance guide before checking coverage, and visit the contact page if you need help navigating the information.
This article is educational information, not medical advice.
This page is informational and is not medical advice.