TMS for TBI

Key Takeaways: 

• Traumatic brain injuries can cause long-lasting cognitive, emotional, and physical symptoms, even after initial recovery.
• TMS is not FDA-approved for TBI, but early research shows potential benefits for mood, cognition, emotional regulation, and overall neural functioning.
• TMS may support recovery by promoting neuroplasticity, stabilizing disrupted brain networks, and helping underactive regions function more effectively.
• Most people tolerate TMS well, with mild and temporary side effects such as scalp discomfort or headache.
• TMS may be considered when traditional rehabilitation has plateaued or when lingering symptoms continue affecting quality of life.

Recovering from a traumatic brain injury (TBI) can feel unpredictable and exhausting. Even after the initial healing period, many people continue experiencing symptoms that interfere with mood, memory, concentration, and daily life. When progress slows or symptoms persist despite rehabilitation, it’s natural to look for additional support.

Transcranial Magnetic Stimulation (TMS) is one therapy gaining attention for its potential role in easing certain TBI-related symptoms. Although TMS is not FDA-approved for TBI, early research suggests that it may support recovery in areas such as cognition, emotional regulation, and post-traumatic depression. At Pulse TMS, patients often turn to us because they want options backed by technology, expertise, and hope.

The following guide explains what TBI is, how it affects the brain, what current research says about TMS for TBI, and who may want to consider this off-label treatment.

A traumatic brain injury occurs when an external force disrupts normal brain function. This can happen after a forceful blow, bump, or jolt to the head or body, or when an object penetrates the skull. TBIs may be referred to as brain injuries, head injuries, or concussions, depending on severity.

• Mild TBI (Concussion): Often results from a blow to the head that leaves someone briefly dazed or confused. Loss of consciousness may or may not occur.

• Moderate TBI: May follow a penetrating or non-penetrating injury and typically causes measurable changes in alertness, memory, or neurological function.

• Severe TBI: Involves prolonged unconsciousness, significant neurological disruption, or structural injury to the brain.

Each category carries its own risks and potential long-term effects.

TBIs can affect multiple systems in the body, and symptoms vary based on severity.

Symptoms of mild TBI may include:

• Headache
• Fatigue
• Nausea
• Trouble sleeping
• Blurry vision or sensitivity to light
• Dizziness
• Ringing in the ears
• Confusion
• Memory problems
• Mood or personality changes
• Brief loss of consciousness

Moderate or severe TBI may include the above symptoms plus:

• Severe or persistent headaches
• Increased irritability or agitation
• Long periods of unconsciousness
• Seizures
• Repeated vomiting
• Slurred speech
• Weakness or numbness in limbs

Some symptoms appear immediately, while others may emerge days or weeks later.

TBI can cause widespread changes in how the brain communicates, heals, and processes information. These effects depend on the force of the injury, the location of the damage, and individual recovery factors.

Potential Complications After TBI

Some people experience medical complications shortly after the injury, such as:

• Seizures
• Blood clots
• Stroke
• Nerve damage
• Infections in the brain
• Narrowing of blood vessels
• Coma

These complications are more likely in moderate or severe TBIs.

Even after initial healing, a TBI may disrupt various brain functions. Some effects resolve over time, while others may last months or years.

Long-term effects may include problems with:

• Cognition: difficulty learning, remembering, making decisions, or reasoning
• Senses: double vision, ringing in the ears, tingling, altered taste, or chronic pain
• Communication: trouble speaking, writing, reading, or expressing thoughts
• Behavior: reduced self-control, difficulty in social situations, aggression, or impulsivity
• Emotions: depression, anxiety, irritability, or mood swings

Some research also suggests that having one or more TBIs may increase the likelihood of later developing neurodegenerative conditions, though this depends on many variables.

These challenges are why researchers continue exploring new rehabilitation approaches, including TMS, for persistent symptoms.

Many TBI survivors continue to experience symptoms months or years after their injury, even with standard rehabilitation therapies. Studies show:

• 10-15% of mild TBI cases result in long-term deficits
• Around 50% of moderate TBI cases show lasting symptoms symptoms
• Severe TBIs have even higher rates of ongoing impairment
• This gap in recovery highlights the need for complementary therapies

TMS, a non-invasive brain stimulation therapy, is one potential option. Although TMS is not FDA-approved for treating TBI itself, early research indicates promising outcomes for specific post-TBI symptoms, including mood issues, cognitive difficulties, and slowed neural functioning.

Health professionals may use TMS off-label, similar to how many other medical treatments are safely used beyond their original approval when research and clinical experience support doing so.

TMS uses magnetic pulses to stimulate targeted regions of the brain. In TBI, certain areas, especially those in the prefrontal cortex, may become underactive or disrupted due to injury.

Although the exact mechanisms are still being studied, research suggests several possible ways TMS may support recovery:

• Reducing interference from dysfunctional regions
  • After TBI, some areas may become hyperactive or inefficient. Low-frequency TMS may calm these regions, allowing healthier areas to function more effectively.
• Promoting cortical reorganization
  • TMS may encourage the brain to shift responsibilities to intact regions, supporting adaptive recovery.
• Enhancing neuroplasticity
  • Neural networks damaged by TBI may regain strength or form new pathways through repeated stimulation.
• Improving network connectivity
  • TMS may reduce “miscommunication” between hemispheres and help stabilize neural signaling.
• Influencing slow-wave and beta activity
  • Some studies suggest changes in slow-wave (delta) activity and beta concordance after TMS, which may correlate with improved attention and cognitive control.

These shifts may support improvements in areas such as concentration, working memory, and executive functioning. Research is still emerging, but these mechanisms show how TMS may influence recovery in meaningful ways.

Because TMS is still being studied in TBI populations, results vary, but several areas show promise:

Cognitive Improvements

Some studies report measurable cognitive benefits, especially when low-frequency TMS is applied to the right dorsolateral prefrontal cortex (DLPFC). Findings include:

• Improvements in attention and executive functioning after 10 sessions
• Enhanced neural plasticity and network stability
• Re-engagement of dormant or underactive brain regions
• The potential for TMS to help the brain strengthen or rebuild pathways makes it an appealing option for patients whose cognitive recovery has plateaued.

Emotional Regulation

Emotional challenges are extremely common after TBI. Many individuals experience:

• Depression
• Anxiety
• Irritability
• Emotional lability

TMS is already FDA-approved for major depressive disorder, giving it a strong safety and efficacy foundation in mood treatment. Early research suggests that similar stimulation protocols may help stabilize mood and ease emotional dysregulation following TBI.

By stimulating networks involved in emotional control, TMS may help improve motivation, reduce irritability, and support overall mental well-being.

Motor Recovery

Although research in this area is earlier-stage, some studies suggest TMS may:

• Improve motor coordination
• Support relearning motor patterns
• Enhance motor cortex excitability
• Complement physical rehabilitation

These effects are not universal, but they represent a promising direction for individuals with motor deficits that have not fully recovered through rehabilitation alone.

TMS for TBI follows the same session structure used for other conditions:

• Treatment typically occurs five days per week
• Each session lasts about 20 minutes
• Patients remain fully awake and can resume normal activities afterward

Most people begin noticing changes, if they occur, during the second or third week of treatment.

Side Effects and Risks of TMS for TBI

TMS is generally well-tolerated, including among those with past TBIs. Possible side effects include:

• Mild headache
• Scalp discomfort
• Temporary lightheadedness
• Fatigue

Serious complications are rare but may include seizures in susceptible individuals. A comprehensive evaluation is essential, especially for patients with a seizure history, penetrating injuries, or implanted metal.

Pulse TMS performs detailed medical screening to ensure TMS is safe and appropriate before beginning any off-label treatment.

TMS may be worth considering for individuals who:

• Experience persistent depression, anxiety, or mood instability after TBI
• Have cognitive symptoms such as reduced attention or mental fatigue
• Have reached a plateau in traditional rehabilitation
• Want a non-invasive, medication-free option
• Are exploring new tools to support long-term recovery

TMS is not a replacement for rehabilitation therapies, but it may serve as an additional support when symptoms remain disruptive.

If you or a loved one is living with the long-term effects of a traumatic brain injury, you deserve access to treatments that offer clarity, hope, and support. At Pulse TMS, we combine advanced Deep TMS technology with personalized care to help patients explore whether TMS may fit into their overall recovery plan.

Contact us today to learn more about TMS for TBI and speak with our clinical team. We’re here to answer questions, offer guidance, and help you take the next step toward meaningful improvement.

Can TMS help with symptoms after a TBI?

• TMS is not FDA-approved for TBI, but early research shows potential benefits for mood, attention, and cognitive functioning. Some patients notice improvements when TMS is added to their rehabilitation plan.

Is TMS safe for people with a history of TBI?

• Most TBI patients tolerate TMS well. Treatment is non-invasive and requires no anesthesia. Mild headache or scalp discomfort can occur, and a clinical evaluation is needed to confirm safety.

What symptoms might improve with TMS?

• Studies suggest possible improvements in depression, anxiety, irritability, attention, and executive functioning. Results vary based on the severity and location of the injury.

How long until I notice results?

• Some people begin to feel changes around week two or three of treatment, while others notice more gradual improvements over the full course.

Can TMS be used with other TBI therapies?

• Yes, TMS can complement physical therapy, cognitive rehabilitation, medication, and counseling. Many patients choose TMS when progress has slowed.

How do I know if I’m a good candidate?

• A clinician will review your symptoms, medical history, and goals. TMS may be considered when mood or cognitive symptoms continue despite standard treatment.

How do I start?

• You can contact Pulse TMS for a consultation to determine whether TMS may be a helpful addition to your recovery plan.