TMS usually feels like a repetitive tapping or knocking on one spot of the head, with a loud clicking sound each time a pulse fires. You are awake and sitting in a chair the whole time, with no anesthesia or needles. Some people also feel the muscles of the scalp, jaw or face twitch or tingle during the pulses, and the treatment area can feel sore or uncomfortable, especially in the first sessions.
For most people that discomfort fades: device safety information says treatment-site pain usually stops being a problem for most patients after the first week. Below is what to expect, moment by moment, and what you can do if it is more uncomfortable than you expected.
Before the first pulse
You sit in a padded chair, fully clothed and awake. You will be asked to remove anything metal or magnetic that can come off, such as earrings, hair clips, glasses or hearing aids, because loose metal can interact with the magnetic field. If you have metal that cannot be removed in or near your head, that is screened for before treatment starts; fillings, braces, implants and tattoos covers what usually matters and what does not.
You will also be given earplugs or headphones. FDA guidance requires hearing protection rated for 30 dB of noise reduction for both patients and staff during treatment. Put them in properly and say so if one feels loose. The coil is then positioned against your head, usually on the left side toward the front.
The first pulses: finding your dose
The first session is different from the rest because the team has to find your motor threshold. Before treatment starts, they send a few single test pulses over the area of the brain that controls your hand. You may feel tapping on your scalp and see your hand or thumb twitch on its own. That twitch is expected, harmless and brief; it is how the team knows the coil is in the right spot and how strong a pulse your brain needs.
Your treatment strength is then set as a percentage of that threshold, and the coil is moved forward to the treatment target. Because of this calibration, the first appointment usually takes longer. The step-by-step version is in the first TMS session: mapping, motor threshold and dose.
During a treatment session
Once treatment starts, the pulses come in short bursts called trains, with rest pauses in between. In standard 10 Hz TMS, each train lasts a few seconds. What people notice most:
- Tapping or knocking under the coil, like a finger flicking the same spot quickly.
- Clicking. Each pulse makes a sharp click. Measurements put the peak sound close to the 140 dB limit for impulsive noise, which is why earplugs are not optional.
- Twitching or tingling of the scalp, jaw or face muscles while a train is running. It stops when the pulses stop.
- Scalp discomfort or pain at the treatment site. It depends on where the coil sits and how strong the pulses are.
- Less common sensations. In NeuroStar's clinical trials, eye pain, toothache, muscle twitching, facial pain and skin pain each occurred in at least 5% of people and at least twice as often as with sham.
You can talk, listen to something quiet or just sit. You need to keep your head still so the coil stays on target; the staff will check its position.
How the protocols compare
The sensation is broadly similar across devices, but session length and intensity differ. This table summarizes what the cleared protocols involve and what trials reported.
| Protocol | Typical session | What stands out |
|---|---|---|
| Standard 10 Hz TMS (figure-8 coil) | About 19 to 37.5 minutes, depending on the pause between trains | Tapping in trains with rests between. Scalp discomfort was the main complaint in the pivotal trial. |
| Theta burst (iTBS) | A little over 3 minutes | Much shorter, but people rated it a little more painful: 3.8 versus 3.4 out of 10 in a large trial. |
| Deep TMS (H-coil) | About 30 minutes, about 20 of them stimulation, in the main depression trial | Uses a helmet-style coil. In the main depression trial, treatment-site pain was reported by 5.0% on active treatment and none on sham. |
| Accelerated protocols | Several sessions a day; SAINT sessions are about 10 minutes, 10 a day | Fatigue and back or neck pain were common in the SAINT trial's active group. |
The trials in this table were run separately, with different patients and different ways of recording side effects, so their numbers cannot be compared directly. Be cautious with anyone who claims one device is clearly gentler. The physician's guide compares the two coils in deep TMS vs standard TMS.
After the session
When the session ends, the tapping and twitching stop. Most people feel normal, though some have a mild headache or feel a little lightheaded or dizzy for a short while.
Because there is no sedation, you can go back to your normal day: work, school, errands. Some providers suggest that someone drive you to and from the very first appointment, until you know how you respond. Ask your own team what they recommend, and see working, studying and driving during a TMS course for the practical side.
What TMS does not feel like
A lot of worry about TMS comes from mixing it up with other treatments. A few clarifications:
- It is not an electric shock. Nothing electrical is attached to your head. Unlike ECT, TMS uses magnetic pulses and does not need anesthesia.
- You do not lose time. You are awake and aware throughout and remember the session. A systematic review cited in international safety guidelines found no reliable evidence of cognitive side effects across 31 randomized trials. The details are in does TMS affect memory or thinking.
- It is not like an MRI scan. The magnetic field is similar in strength to an MRI scanner's, but it comes from a small coil resting on one spot of your head, not a tunnel you lie inside.
- You should not feel your mood change during a session. Benefits, when they come, build up over weeks of treatment, not minutes.
If you feel nervous before the first session
Feeling anxious beforehand is common and reasonable; it is a new procedure, and the first visit is the longest. It can help to ask the team to fire a single pulse before treatment starts, so you know what the tap and click are like before a full train begins. Ask them to describe each step as they go, and agree on a simple signal for "please pause". Bringing a support person to the first visit, if the clinic allows, can make the trip easier.
It also helps to know that the uncomfortable parts are short. Each train lasts seconds, and the rests in between give you a break. If you have questions you want answered before you commit, the TMS consultation guide lists what to ask.
Your first week, and why it usually gets easier
The first few sessions are usually the most uncomfortable. Two things help. First, for people who are very sensitive, many clinicians build up the dose gradually over the first week instead of starting at full strength. Second, people generally get used to the sensation; an expert consensus noted that patients usually develop tolerance to scalp discomfort over the first two weeks.
That matches what device makers report from trials. NeuroStar's safety information says treatment-site pain and discomfort are temporary and, for most patients, do not occur after the first week. In the pivotal NeuroStar trial, 4.5% of patients stopped because of side effects, which were mostly short-lived scalp discomfort or pain. So most people who find the first days unpleasant do get through the course.
What the course feels like later, including when mood changes tend to show up, is in a typical TMS course, week by week.
Ways to make TMS more comfortable
Discomfort is worth mentioning early rather than toughing out. Things you can ask about or do:
- Say how it feels, in numbers. "It's a 6 out of 10 on the left side of my forehead" gives the technician something to work with.
- Ask about a gradual start. Building intensity up over the first sessions is a common approach for people who are sensitive to the pulses.
- Check the earplugs. A loose earplug lets the click through; one case of permanent hearing change in the research literature followed an earplug slipping out.
- Ask before taking a pain reliever. Your psychiatrist can tell you what is safe with your other medications.
- Keep the rest of your routine steady. Sleep loss and heavy drinking can lower the seizure threshold, so they matter during a course. See caffeine, alcohol and sleep during TMS.
The TMS preparation checklist collects the practical items in one place.
Sensations that are not normal
Tapping, clicking, twitching during trains and scalp soreness are expected. These are not, and you should tell the staff right away or call your treating clinician:
- Hearing loss, ringing in the ears or a feeling of fullness after a session; these call for a hearing check.
- A headache that is severe or does not ease.
- Fainting, confusion or any jerking movements that continue after the pulses stop.
- Mood changes that worry you, such as feeling unusually revved up, not needing sleep, or depression getting worse.
If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
Seizures are rare, but they are the most serious risk; one survey found fewer than 1 per 60,000 sessions when guidelines were followed in people without risk factors. For the full list of side effects and what to do about each, read TMS side effects.
For more on how TMS works and what else to expect, browse the TMS patient guide, or read the TMS therapy page.
Sources
- 510(k) Summary K231926: NeuroStar Advanced Therapy System. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
- 510(k) Summary K220177: Magnus Neuromodulation System with SAINT Technology. U.S. Food and Drug Administration, 2022. accessdata.fda.gov
- Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Archives of General Psychiatry, 2010. pubmed.ncbi.nlm.nih.gov
- 510(k) Summary K173620: MagVita TMS Therapy System w/Theta Burst Stimulation. U.S. Food and Drug Administration, 2018. accessdata.fda.gov
- Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry, 2015. pmc.ncbi.nlm.nih.gov
- Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet, 2018. pubmed.ncbi.nlm.nih.gov
- Seizures from transcranial magnetic stimulation 2012-2016: Results of a survey of active laboratories and clinics. Clinical Neurophysiology, 2019. europepmc.org
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, 2021. europepmc.org
- Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological Psychiatry, 2007. pubmed.ncbi.nlm.nih.gov
- Safety Information. Neuronetics (NeuroStar), 2026. neurostar.com
- Side Effects. Neuronetics (NeuroStar), 2026. neurostar.com
- Class II Special Controls Guidance Document: Repetitive Transcranial Magnetic Stimulation (rTMS) Systems. U.S. Food and Drug Administration, 2011. fda.gov
- Brain Stimulation Therapies. National Institute of Mental Health, 2024. nimh.nih.gov
- Transcranial Magnetic Stimulation (TMS). Cleveland Clinic, 2026. my.clevelandclinic.org
- The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder. Brain Stimulation, 2016. pmc.ncbi.nlm.nih.gov
FAQs
Does TMS hurt?
It can be uncomfortable, especially at first. Most people describe tapping and scalp soreness rather than sharp pain, and for most people discomfort fades after the first week as they get used to it.
Will I be asleep or sedated?
No. TMS needs no anesthesia or sedation. You sit in a chair, awake and able to talk, and can go back to your normal day afterward.
Why did my hand twitch during the first session?
That is how the team measures your motor threshold. A pulse over the hand area of the brain makes the fingers or thumb move, which tells them how strong your treatment pulses need to be.
How loud is TMS?
Loud. Each pulse makes a sharp click, and measured peaks come close to the safety limit for impulsive noise, so earplugs or similar hearing protection are required for every session.
Is it normal to feel tired after TMS?
Some people feel tired or a little lightheaded briefly, and fatigue was common in one accelerated protocol trial. Tell your team if tiredness is strong or lasts.
