Does TMS Hurt?
If you’re wondering if transcranial magnetic stimulation hurts, the most common description patients give is that it feels strange or unusual rather than painful. Everyone has different tolerances for sensation and pain, resulting in a unique experience for each person, but TMS therapy is generally not considered painful.
The sensation that people describe as strange comes from the magnetic pulses stimulating small nerves and muscles beneath the scalp. This can cause a brief tingle or muscle twitch while the pulses are being delivered. The sensation eases during the pauses between pulses.
Some people also experience discomfort where the coil meets their scalp during the pulses, especially early in treatment. It may take a few appointments for you to get used to the procedure. If a setting feels too intense at any point, your care team can make immediate adjustments to keep you comfortable. You just need to let your provider know when you need support. You can find specific ways your technician can customize your treatment to make TMS more comfortable down below in this article.
What Does TMS Feel Like?
Most people notice a few distinct sensations during a TMS session. Knowing what these sensations may feel like ahead of time should make your TMS experience easier:
- A tapping or knocking sensation on your scalp. When the machine delivers magnetic pulses, you will feel a light, repeated tapping where the coil rests against your head. The pulses come in short bursts, with pauses in between. The sensation is similar to someone gently tapping a fingertip against your scalp.
- Clicking sounds. Each pulse produces a clicking noise. The sound can be fairly loud, so you will wear earplugs during treatment to protect your hearing.
- Tingling or a mild pulling sensation. Some people notice tingling or a slight pulling feeling around the scalp, forehead, or jaw. You may also feel a gentle twitch in your face or jaw muscles while the pulses are being delivered. These sensations are expected, and they stop when the pulses stop.
- Light pressure where the coil rests. You may feel some pressure from the treatment coil against your scalp. Your care team will position it carefully and can help if the placement feels uncomfortable.
- Temporary mild scalp tenderness or discomfort. Some people experience tenderness in the area where the coil sits. This is usually mild. If the sensation becomes uncomfortable, let your technician know so they can assess the coil position and treatment settings.
- A mild headache. Some people develop a headache during or shortly after a session. These headaches are generally mild and tend to settle shortly after treatment. If yours lingers or becomes bothersome, tell your care team right away.
Because TMS does not require anesthesia or sedation, you will remain awake and alert throughout the appointment so you can communicate with your technician the whole time in case you get uncomfortable during treatment.
If depression hasn’t improved with medication and you’re considering TMS, our team is happy to talk through treatment options. Most new patients are seen within 1-3 days.
What Happens at Your First TMS Appointment
Your first TMS appointment is usually the longest because it includes a few steps that are not repeated during every session. The process may feel unfamiliar at first, but your care team will walk you through exactly what happens. Understanding TMS session details is the best way to feel at ease during your actual treatment.
Before the Treatment Starts
Your initial psychiatric evaluation is intended to be a low-pressure precursor to your full treatment experience. Before beginning TMS, your provider will chat with you in a relaxing environment to explain what to expect at your first TMS session and every session thereafter. They will review your full medical and mental health history, current medications, and previous depression treatments. Don’t rush past this very important step. Your care team is there to help you, and discussing any concerns you have and disclosing previous treatment experiences with your provider is the best way for them to do that.
You may be asked about a history of seizures, head injuries, implanted medical devices, or metal in or near your head. Your provider may also ask about pregnancy and other relevant health considerations. Be sure to mention any medications or supplements you take, even if they do not seem related to your mental health.
You may need to remove metal items near your head, such as earrings or hairpins, before treatment. These questions and precautions help your care team identify potential risks and determine whether TMS is appropriate for you.
Finding Your Treatment Spot (Mapping)
In some cases, mapping may take place at the consultations, and other times it will happen at your first TMS appointment. During this step, the care team uses short test pulses to identify the right location on your head and determine the appropriate stimulation strength for your treatment.
You may notice your thumb or fingers twitch briefly during this process. This natural reflex is normal and expected. It helps the team identify the stimulation level needed to personalize your treatment.
Mapping can feel stronger or more unusual than a regular TMS session because the team is finding the settings that work best for you. For most people, the brief test pulses are not painful, although you may notice the tapping more clearly. Once your treatment location and settings are established, later appointments generally feel more routine.
Your First Treatment
Once mapping is complete, you will settle into a reclining chair and put on your earplugs so you can sit back and relax while the treatment coil is positioned against your scalp. A Certified Technician will deliver your treatment and remain nearby throughout the entire session.
To help you relax during treatment, individual rooms are designed with patient comfort in mind, offering TVs equipped with streaming apps and calming videos. You are also welcome to bring comfort items from home, such as a cozy blanket or slippers, provided they do not contain batteries or metal items that could interfere with the magnetic field.
The length of a TMS session depends on the treatment protocol being used. Some protocols take only a few minutes, while others may take closer to 40 minutes. Your care team will explain the schedule and what to expect during your appointments.
After your first visit, treatment typically involves sessions five days a week for about four to six weeks, typically totalling 36 sessions scheduled out in advance. Your provider will work with you to decide on the best schedule for you and help you understand how each appointment fits into the overall treatment plan.
How to Make TMS More Comfortable
The most important thing to keep in mind is the fact that you can speak up the moment things feel uncomfortable or out of the ordinary. If you notice that the tapping feels particularly uncomfortable in one area, tell your care team and describe exactly where you feel it. If you develop a headache or scalp soreness that continues after your appointment, mention it at your next visit.
It’s normal to feel hesitant about speaking up during treatment, but your care team depends on your feedback. A few simple reminders can help you feel more comfortable speaking up:
- Describe the sensation. Let your technician know if you feel tapping, pressure, tingling, or soreness in a particular spot.
- Speak up early. You do not have to wait for discomfort to become more noticeable before mentioning it.
- Share what happens afterward. Tell your provider if you have a headache or tenderness that lasts beyond the appointment.
- Ask what can be adjusted. Your care team can explain which changes are possible with your treatment protocol.
The goal is to make depression treatment manageable while keeping it aligned with your provider’s recommended plan.
What to Expect After a TMS Session
Patients are often relieved to learn that TMS requires no sedation or recovery period. Most people can drive themselves home and return to work or their usual activities immediately after a session.
You may have some scalp tenderness or a mild headache afterward. These effects are generally short-lived and tend to improve shortly after treatment. Some people also notice a change in their energy or mood. You might feel more energized after a session, while another day you may feel tired. Every patient is different.
It’s also important to have realistic expectations about when you may notice improvement. TMS is a course of treatment, and changes in depression symptoms generally build over several weeks rather than appearing after one appointment.
Some people experience a temporary increase in symptoms or feel worse before they begin to feel better. This is normal. If you notice a change in your mood or depression symptoms that concerns you, tell your care team. Your provider can help you understand what is happening and determine whether your treatment plan needs attention.
If you’re wondering what to expect after TMS treatment, remember that your experience may change as you move through the sessions. Keep your care team informed about how you feel during and between appointments.
Common Side Effects and Rare Risks
Most TMS side effects are mild and improve shortly after a session. The most commonly reported include:
- Scalp discomfort or tenderness where the coil rests
- Mild headaches
- Tingling or twitching in the scalp, face, or jaw muscles
- Brief lightheadedness or dizziness
These effects are usually temporary. Your provider can discuss ways to manage them and determine whether adjustments are appropriate.
Rare Risks & Considerations
As with all medical treatments, there are some less common but more serious risks:
- One of the easiest to combat is hearing issues associated with the loud clicking produced by the machine. It’s extremely important to use the earplugs provided by your care team to prevent these issues.
- Seizures are also a rare potential side effect of TMS. Your provider will review your medical history, including any history of seizures or conditions that may affect seizure risk, before recommending treatment.
- Mania is another uncommon risk, particularly for people with bipolar disorder. If you have a history of bipolar disorder or have experienced periods of unusually elevated mood, make sure your provider knows.
TMS may not be appropriate for people with certain non-removable metal objects or implanted devices in or near the head. Some devices and metal objects can be affected by the magnetic field. Tell your provider about any implants, medical devices, metal in your body, seizure history, head injuries, and medications you take. Your care team will review these details before treatment begins.
Frequently Asked Questions About TMS
TMS is usually described as a tapping or knocking sensation against the scalp rather than pain. The feeling may be unusual at first, especially when you are not sure what to expect. Some people experience mild scalp discomfort or tenderness, particularly during the first few sessions. It’s always possible for your provider to adjust the stimulation settings if needed.
For many people, TMS becomes more comfortable as they get used to the sensation of the magnetic pulses. The tapping may feel less noticeable after the first several sessions, as the treatment becomes part of a familiar routine. However, everyone responds differently, and discomfort does not always disappear on its own. If you continue to experience soreness or discomfort, tell your provider so they can discuss possible adjustments.
No. TMS does not require sedation or anesthesia, so you remain awake and alert throughout the session. You can communicate with your technician and let them know if you are uncomfortable at any point. Because you are not sedated, you generally will not need time to recover before leaving the office. This also means you can typically return to your normal daily activities after treatment.
In most cases, yes. TMS does not involve sedation, so patients can typically drive themselves home after a session. Many people also return to work, errands, and other everyday activities without needing additional recovery time. Your care team will review your individual circumstances and let you know if any specific precautions apply.
Depending on the treatment protocol, TMS sessions can range from a few minutes to about 40 minutes. At Advanced Psychiatric Health, appointments are scheduled for 30 minutes, with active stimulation lasting between 20 and 30 minutes. Your first treatment appointment takes longer because it includes the mapping process to identify your precise treatment location and settings.
Tell your technician or provider as soon as you experience discomfort. You do not need to wait until the session is over or try to push through a sensation that feels too intense. Your care team may be able to lower the stimulation intensity, adjust the coil position, or pause treatment to address the problem. If discomfort continues between appointments, bring it up with your provider before your next session so you can discuss how to make treatment more manageable.
Ready to Talk About TMS?
It is normal to feel uncertain before trying a treatment you have never experienced, especially if you’re still trying to decide between multiple treatment options. You will have plenty of opportunity to ask your care team questions and share how you are feeling before, throughout and after your treatment.
Advanced Psychiatric Health offers TMS at several Florida locations. If you are considering TMS for depression or OCD, schedule an appointment to discuss your symptoms and find out whether treatment may be appropriate for you.