By Dr. David Woo - September 19, 2022

One question I’m often asked when discussing transcranial magnetic stimulation with my patients is, “Does TMS hurt?” 

TMS is a painless procedure performed while patients are awake and alert, and requires no anesthesia. While some patients may report some scalp discomfort, this usually subsides after the first week of treatment. 

What Is TMS?

TMS is a noninvasive treatment that uses magnetic pulses, delivered by a magnetic coil placed over the head, to regulate activity in certain regions of the brain associated with specific mental health disorders. As opposed to antidepressants and other medications that aim to chemically regulate brain activity, TMS stimulates brain cells electrically.(1)TMS is proven to be a safe, effective, and well-tolerated treatment for major depressive disorder, anxious depression, and OCD (obsessive-compulsive disorder) with few and mild side effects.(2,3,4) TMS is especially effective for patients who are considered treatment-resistant—those who have not had success with prescription medications.

Is TMS More Painful Than Depression?

Depression can be emotionally and physically painful, and the frustration that some patients feel when they don’t find relief with medication can add to their feelings of hopelessness.

TMS is not only an effective treatment for those who have not found relief with antidepressants, but is:

• Painless
• Free of systemic side effects
• Proven to be long-lasting 

In fact, by treating the symptoms of depression, TMS can help relieve the physical pain that can accompany chronic depression. 

What Does TMS Feel Like?

During a TMS session, you’ll feel a slight tapping sensation on the head, which may be uncomfortable for the first few sessions. Some patients report short-term scalp discomfort and mild headache, both of which can be treated with over-the-counter pain medication, like Tylenol or Ibuprofen, and subside after the first week of treatment. 

Scalp discomfort is thought to be related to the stimulation of nerves located on the scalp from the TMS device or an uncomfortable position during treatment, while headaches are potentially caused by an increase in blood flow caused by stimulation of the scalp.(5,6)

My patients who complain of scalp discomfort or pain generally report a decrease in these side effects within the first week of treatment, and studies show that other TMS patients who experience scalp discomfort or headache have a similar experience. 

One study demonstrated that, over the course of 15 consecutive treatments in a three-week period, participants who reported pain, said that it was at its highest during the first treatment and reduced by an average of 37% by the end of the study, with most of the reduction occurring during the first three days.(7)

What Happens if You Feel Discomfort During TMS Treatment?

The majority of patients who undergo TMS treatment do not experience discomfort and adapt to the treatment in just a few sessions. However, if you find that the tapping sensation is uncomfortable, be sure to talk to your technician. There are a few things the technician can do to help reduce discomfort, such as:

• Adjusting the position of the coil
• Lowering the frequency and therefore the intensity of the magnetic pulses
• In some cases, moving the treatment location

TMS sessions last about 20 minutes and are performed while you are awake and alert, meaning that you can return to work or your daily routine immediately following a treatment session.

Resources:

1. Transcranial Magnetic Stimulation. MayoClinic. Published November 27, 2018. Link. Accessed August 25, 2022.

2. Somani A, Kar SK. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr. 2019;32(4):e100074. Accessed August 25, 2022.

3. Pell GS, Harmelech T, Zibman S, Roth Y, Tendler A, Zangen A. Efficacy of Deep TMS with the H1 Coil for Anxious Depression. J Clin Med. 2022;11(4):1015. Accessed August 25, 2022.

4. Carmi, L., Tendler, A., et al. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry. 2019;176(11):931-938. Accessed August 25, 2022.

5. Loo CK, McFarquhar TF, Mitchell PB. A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. Int J Neuropsychopharmacol. 2008;11(1):131-147. Link. Accessed August 22, 2022.

6. Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol. 1998;108(1):1-16. https://pubmed.ncbi.nlm.nih.gov/9474057/. Accessed August 22, 2022.7. Borckardt JJ, Nahas ZH, Teal J, et al. The painfulness of active, but not sham, transcranial magnetic stimulation decreases rapidly over time: results from the double-blind phase of the OPT-TMS Trial. Brain Stimul. 2013;6(6):925-928. Link. Accessed August 22, 2022.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.