What a course of rTMS actually feels like

The short answer

You sit upright in a chair, awake, in a low-lit room. A coil rests against your scalp and delivers pulses in short trains, with rests in between. Most people describe a light tapping and little else.

There is no anaesthetic, no sedation and no recovery time. You can drive yourself home afterwards. Nobody needs to collect you.

It starts with a free consultation

Your first appointment is fifteen minutes with a clinician and costs nothing. You talk about what you are dealing with, what has already been tried, and whether stimulation is likely to help. If it is not appropriate for you, they will say so then rather than later.

That conversation also covers screening, which is not a formality. We ask about ferromagnetic metal in or near your head, including aneurysm clips, cochlear implants and deep brain stimulators. We ask about an implanted pacemaker or defibrillator, and about any history of epilepsy or unprovoked seizure.

Recent significant head injury or intracranial surgery is also a reason to pause. Pregnancy and breastfeeding are assessed individually at consultation rather than assumed either way. These questions decide whether a course can begin at all.

Bring the names and doses of any medication you take, and a rough history of what has been tried and for how long. If you have had a previous course of stimulation elsewhere, the protocol and the number of sessions are useful to us. None of it needs to be formal or written up.

Nothing is delivered before something is measured

Your first clinical appointment establishes your motor threshold. The coil sits over the part of your brain that controls hand movement, and the pulse strength is raised until a small twitch appears in your hand. That figure is yours, and every dose you receive afterwards is set as a percentage of it.

You will also have a NayaScore assessment. It combines grip strength, continuous heart rate variability recorded by a wearable ring, and cognitive testing across twelve domains. Scores come back as percentiles against people of your own age and sex.

The NayaScore is a measurement tool, not a diagnostic test. It does not name a condition and it does not replace a clinical opinion. Your clinician reads it alongside your history and their own judgement.

Then we find your target

Rather than fixing a scalp coordinate, we test candidate sites over the dorsolateral prefrontal cortex. At each site we watch how your heart responds to the test pulses. The site producing the clearest slowing of heart rate is the one we treat.

That brief slowing indicates the network linking the front of the brain to the vagus nerve has engaged. Our guide to how a target is chosen sets out what that does and does not tell us.

What a session actually feels like

The coil is positioned, then the pulses begin. They arrive in short trains with rests between them, and the tapping is felt on the scalp rather than inside your head. Many people find the first session odd rather than uncomfortable.

By the third or fourth session most people stop noticing it. You can read, listen to something, or simply sit. You stay awake throughout, and you can ask for a pause at any point.

Session length depends on the protocol, so we will not quote you a single universal figure. Etienne Balland, writing in The Telegraph on 16 March 2026 about his own treatment for chronic fatigue syndrome, described sessions of fifteen to twenty minutes. Greg Smith, whose Optimise case study we publish with his consent, had three minutes of stimulation in each of his sessions.

The rest of your day

You can drive, work and exercise straight afterwards. Sessions are deliberately scheduled around working days, and most people come in before work or over lunch.

Avoid alcohol the night before a first session, because it lowers the seizure threshold. Otherwise eat, drink and take your usual medication as normal, unless your clinician has told you otherwise. Leave earrings and hair clips out, and skip heavy hair product, because the coil needs flat contact with your scalp.

Side effects, stated plainly

Mild scalp tenderness or a dull headache is the most common side effect. It is more likely early in a course and usually settles within an hour or two. Ordinary painkillers are fine.

Seizure is the serious risk. It is rare, and it is the reason the screening questions are asked before anyone is treated. Tell your clinician if a headache is severe or persistent, and contact the clinic immediately after any loss of consciousness or seizure-like episode.

When people start to notice something

There is no standard week in which change arrives, and we will not predict one for you. Mr Balland reported improvement within two weeks, and a decisive change by week three. That was his experience of one course for chronic fatigue syndrome, not a timetable.

Some people notice sleep before mood. Some notice nothing for several sessions and then something shifts. Others reach the end of a course with little change, which is exactly why we measure rather than ask you to recall.

How long a course takes

The honest answer is that it varies, and the number depends on what is being treated. Courses at this clinic have ranged from five sessions for cognitive work to thirty for complex chronic fatigue.

Mr Balland described thirty sessions in his first course, sometimes two or three in a single day. Mr Smith had five sessions across seven weeks. An accelerated protocol compresses the calendar by delivering several sessions a day over a small number of days, and whether it suits you depends on the condition and on your own circumstances.

You will be given a specific number after your assessment, not before it.

The initial consultation is free and lasts fifteen minutes. A single rTMS session is from £350. Peripheral magnetic stimulation, where a body site rather than the head is treated, is from £250 per session.

Reassessment, and the conversation at the end

The NayaScore assessment is repeated during a course. The question of whether this is working then gets answered with numbers, while there is still time to act on the answer, rather than from memory once the course has finished.

Not everyone responds. If the measures are not moving, we will tell you and stop. Some people finish a course and need nothing further, others agree top-up sessions, and relapse followed by a second course is a normal part of the picture rather than a failure.

Bottom line

The unglamorous version is the accurate one. A quiet room, an upright chair, a tapping sensation on your scalp, and a drive home afterwards. The work that makes it precise happens in the measurement before the first pulse, and in the reassessment that tells you whether to carry on.

Frequently asked questions

Does rTMS hurt?

Most people describe a light tapping against the scalp and nothing worse. The first session can feel odd rather than painful. Mild scalp tenderness or a dull headache afterwards is the most common side effect, and it usually settles within an hour or two. Ordinary painkillers are fine.

Can I drive and work after a session?

Yes. There is no anaesthetic and no sedation, so you can drive yourself home and return to work straight afterwards. Most people schedule sessions before work or over lunch. Exercise is fine the same day. Tell your clinician if a headache is severe or persists beyond a couple of hours.

How long is a single rTMS session?

It depends on the protocol, so there is no single figure. The Optimise case study we publish with consent involved three minutes of stimulation per session. Etienne Balland, writing in The Telegraph in March 2026, described sessions of fifteen to twenty minutes. Your clinician will confirm your own session length.

What are the side effects of rTMS?

Scalp discomfort and a dull headache are the common ones, usually settling within a couple of hours and easing early in a course. Seizure is the serious risk and it is rare. We screen for metal in the head, cardiac devices and seizure history before anyone is treated here.