Side effects: what is common, and what warrants a call to your clinic

A recurring question in this category is some version of "is this normal?" Here is the general shape of it, drawn from the published safety literature rather than from any one person's course. **Common, and usually settles within the first week or two** - Scalp discomfort at the treatment site during pulses. Often rated 4–6 out of 10 in the first sessions, dropping as you habituate. - Mild headache afterwards, in roughly 20–30% of people early on. Usually responds to ordinary analgesics. - Facial or jaw twitching during stimulation. Uncomfortable, not harmful — coil position can often be adjusted. - Transient lightheadedness right after a session. **Worth raising with your clinic, without alarm** - Headaches that are not improving after two weeks, or getting worse. - Pain severe enough that you are dreading sessions — protocols and coil placement can be adjusted, and enduring it silently is not the goal. - Noticeable sleep disruption, or a sharp change in energy or agitation. Sleep changes can be an early response signal, but they can also indicate a shift worth reviewing — particularly for anyone with bipolar-spectrum history. **Seek prompt medical attention** - Any seizure activity. Rare — on the order of a few events per tens of thousands of sessions — but it is the reason for the screening questionnaire. - Sudden hearing change or persistent ringing. Ear protection during sessions is standard for this reason; tell your clinic if it was not offered. Deeper detail: [the complete side-effects guide](/blog/tms-side-effects-complete-guide/) and [headaches specifically](/blog/tms-side-effects-headache/). If you are dealing with something not on this list, post it. Odds are good someone else has had the same question.