Does TMS Cause Headaches?

Transcranial Magnetic Stimulation (TMS) is a highly safe and effective procedure for the treatment of depression. Since TMS delivers a series of magnetic pulses to the prefrontal cortex for roughly twenty minutes, giving the sensation of a rapid and repetitive “tapping” on the scalp, it’s reasonable to wonder? Will TMS cause or worsen headaches, especially if I’m prone? What if I suffer from migraines? Is TMS safe for migraines? The simple answer is: yes! 

Tensions Headaches

Along with transient scalp pain, headache is one of the few side effects that some patients may experience with TMS treatment. A review of randomized trials in patients with major depression found that the incidence of headaches with active and sham treatment was 28 vs. 16 percent. However, most headaches are isolated and reported to be mild and short-lived, with the incidence decreasing as the course of treatment progress and generally resolving over the first two weeks. Data from a small 2021 paper suggests that high-frequency rTMS can actually be effective in reducing the intensity and frequency of chronic tension-type headaches over the long term, notwithstanding the risk of precipitating mild, isolated headaches in the short term.

If headaches do occur, they can respond to regular over-the-counter analgesics (i.e., acetaminophen or ibuprofen). If you have a headache before starting a treatment session, TMS can still be safely administered as long as it is tolerable. If needed, the intensity of the stimulation can be lowered, and ear plugs can be worn to decrease sensitivity to sound.  

Migraines

Whereas mild headaches can occur in a small percentage of patients following TMS, there is no evidence to suggest that TMS causes migraines (debilitating headaches often associated with nausea and sensitivity to light or sound). In fact, at the right frequency and location, TMS technology can be an effective solution for treating migraines. The FDA has even approved the use of several portable single-pulse (low frequency) TMS machines for treating migraines. Generally placed at the back of the head, these devices work by calming hyperactive nerves that trigger migraine pain, thereby decreasing the intensity of migraines and preventing future attacks from occurring.  

It’s important to keep in mind, however, that the frequency and location of TMS that is FDA-approved for treating migraines is different from the frequency and location of TMS indicated for treating major depressive disorder. However, a 2022 systematic review of 8 randomized clinical trials concluded that the kind of stimulation used in depression protocols (repetitive high-frequency pulses directed at the left dorsolateral prefrontal cortex) “seems to have positive effects on both migraine pain severity and attack frequency compared to sham stimulation.” The authors noted that while the effect on pain intensity was small, TMS reduced pain frequency by eight days per month on average. TMS has been found to work for migraine episodes that occur both with and without aura (the “warning signs,” often visual changes, that precede a migraine) and for people of all ages.

Bottom Line

Like all treatments, TMS doesn’t work for everyone, whether due to individual differences in efficacy, side effects, or ability to adhere to the full treatment protocol. But for people who have trouble tolerating medicines, or who prefer non-invasive treatments over medicine, the science supports the use of TMS in those with headaches and migraines.

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