Transcranial Magnetic Stimulation at NYHC

Transcranial Magnetic Stimulation for Migraine and Neurological Disorders

When medications aren't enough or side effects have become a problem, TMS
offers a non-drug treatment path.

An Advanced, Non-Invasive Approach to Neurological Pain

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TMS is an advanced, non-invasive treatment option for selected patients with difficult-to-treat migraine and other neurological disorders. Transcranial Magnetic Stimulation (TMS) uses focused magnetic pulses that are delivered from a magnetic coil placed against the scalp to modulate electrical activity in targeted regions of the brain. There is no sedation, no pain, and no recovery time.
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In the context of migraine and chronic headache, TMS works by modulating neural circuits involved in pain processing, cortical excitability, and abnormal brain activity patterns that drive recurrent attacks. Research has shown that patients with migraine often exhibit heightened cortical hyperexcitability, a state in which the brain's pain networks are abnormally sensitive to triggers. TMS can help lower this sensitivity and reduce the frequency and intensity of attacks without adding another drug to your regimen.
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For patients who have struggled with medication side effects such as weight gain, cognitive fog, fatigue, mood changes, or who simply haven't responded well enough to standard drug therapies, TMS represents a fundamentally different mechanism of treatment: one that addresses brain function directly rather than through systemic medication.

TMS in a Headache and Neurology Setting

Most people hear about TMS in connection with depression treatment because it is much more widely used compared to neurological disorders. One reason is that TMS is approved by the FDA for the treatment of depression and OCD. New York Headache Center is one of only two specialty neurology practices in NYC that use TMS for neurological disorders. We use TMS to treat migraines, chronic headaches, post concussion headaches, chronic pain, brain fog, memory disorders, and other complex neurological disorders.

This distinction matters. A psychiatric TMS program and a neurological TMS program may use similar equipment, but we use multiple and varied brain targets (depression is treated only over one spot), different stimulation parameters, and treatment protocols.

Patient consultation at the New York Headache Center.

When Standard Migraine Treatments Haven't Been Enough

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Common neurological indications for TMS:

Chronic and episodic migraine that persists despite preventive and abortive medications, Botox injections, CGRP-targeted therapies, supplements, and others.
Intolerable side effects from oral preventives (topiramate, amitriptyline, beta-blockers,valproate) or injectable biologics, leaving few pharmaceutical options remaining.
Patients who prefer or medically require a non-pharmacological approach, including those who are pregnant, planning pregnancy, or managing complex medicationinteractions.
Medication overuse headache (rebound headache), where the cycle of acute medication use has itself become part of the problem.
Post-concussion headaches with brain fog, memory and concentration difficulties, where standard headache medications have limited effectiveness and the underlying pathology involves disrupted neural networks.
Cluster headache, trigeminal neuralgia, or other severe pain syndromes that have not responded adequately to standard treatments.
Long-COVID with brain fog, fatigue, concentration, and memory difficulties.
Alzheimer’s and Parkinson’s disease symptoms, such as impaired memory, walking, sleep, and mood, can be improved, and the progression of the disease can possibly be slowed.

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If you have been through multiple treatments without adequate relief, TMS may be a reasonable next step to discuss with one of our specialists.

Precision-Targeted Stimulation, Not a One-Size-Fits-All Protocol

At New York Headache Center, we go beyond standard TMS delivery. Our practice integrates advanced technology to improve targeting accuracy and individualize treatment for each patient's neurological condition.

Neuronavigation-guided TMS: We use a neuronavigation system to map the patient's brain connectivity patterns and direct magnetic pulses to specific cortical targets. This ensures that stimulation reaches the intended brain regions involved in your specific condition, rather than relying on typical targets and approximate surface landmarks alone.
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Functional MRI (fMRI) integration: Because of Dr. Mauskop’s academic affiliation (he is a Professor of Clinical Neurology at SUNY Downstate Health Sciences University), we have access to a research facility that performs functional MRIs, or fMRI. In some cases, we incorporate data from resting-state functional MRI scans to better identify the specific brain networks that are most dysregulated in a given patient. This allows for a further degree of personalization.

Protocol selection based on diagnosis: The stimulation frequency, intensity, duration, and brain target all vary depending on what neurological condition we are treating.

What to Expect During TMS Sessions

Before treatment: There are no special preparations required. You can eat, drink, and take your usual medications. You do not need someone to drive you to or from the appointment.
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During the session: You sit in a comfortable chair while a TMS coil is positioned against your head at the targeted location. The device delivers a series of brief magnetic pulses. Most patients describe the sensation as a rhythmic tapping on the scalp, noticeable but not painful. You remain fully awake and conversational throughout. Sessions typically last between 20 and 45 minutes, depending on the stimulation protocol being used.
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After the session: You can return immediately to normal activities — work, driving, exercise. There is no sedation, no cognitive impairment, and no downtime.
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Treatment schedule: TMS is not a single-session treatment; meaningful clinical improvement often develops gradually over several weeks. Many patients begin with a series of more frequent sessions (often several per week) during an initial treatment phase, then transition to a less frequent maintenance schedule. The total course of treatment varies by condition and response.

Important Expectations

TMS Is Not Right for Every Patient

TMS has demonstrated meaningful benefit for many patients with migraine and other neurological headache conditions, but because of the lack of large controlled trials, only psychiatric conditions carry FDA clearance. However, the evidence base continues to evolve with scientific articles appearing every month. Clearly, not every patient will respond. TMS works best as part of a broader treatment plan, not always as a standalone solution.

A Neurological Framework, Not a Depression Protocol

The majority of TMS clinics in the United States are built around the treatment of depression and other psychiatric conditions.
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Our patients are not seeking treatment for depression, although depression often accompanies chronic neurological conditions. We have seen patients with neurological disorders whose depression, anxiety, and phobias lifted. We have also seen patients who received treatment for their depression and noticed improvement in their migraine headaches. This is consistent with the fact that migraine and depression share neural circuits, neurotransmitters (e.eg. serotonin), and both respond to treatment with antidepressants.

frequently asked questions

Common Questions About TMS for Migraine

Is TMS covered by insurance?

Insurance coverage for TMS is more widely established in psychiatric settings for depression, but not for neurological disorders. We recommend discussing the specifics during your consultation so we can help you understand your options and your out-of-pocket costs before treatment begins.

Is TMS experimental, or is it an established treatment?

TMS was cleared by the FDA for depression over 15 years ago. A prescription single-pulse TMS device (eNeura) is FDA- cleared specifically for the acute and preventive treatment of migraine. Single pulse, as the name implies, delivers one magnetic pulse at a time. For prevention, 4 pulses are administered twice a day. TMS for depression and neurological disorders delivers thousands of pulses during each
session.

Is this the same TMS used for depression?

The underlying technology delivering magnetic pulses to the brain is the same. However, the clinical application is fundamentally different. Depression TMS typically targets the left dorsolateral prefrontal cortex to modulate mood-related circuits. Neurological TMS targets different brain regions involved in pain processing, cortical excitability, and sensory modulation. The protocols, brain targets, treatment schedules, and clinical goals are specific to the neurological condition being treated.

Does TMS hurt?

Most patients find TMS well tolerated. The most common sensation is a tapping or knocking feeling on the scalp at the site of stimulation. Some patients experience mild scalp discomfort during the first few sessions, which typically diminishes as they acclimate. TMS does not require anesthesia or sedation, and serious side effects are rare.

What are the potential side effects?

The magnetic coil makes a loud clicking noise (not as loud as an MRI machine, which also produces magnetic pulses), which ironically can be a trigger for a headache. We provide earplugs to reduce the noise. Some patients have felt dizzy,
but this is mild and transient. People who have epilepsy or a predisposition to epilepsy should not receive TMS. This is why it is important to have a neurological assessment before starting TMS.

Freedom from migraines may include Transcranial Magnetic Stimulation treatment. Contact us to learn more.

If you’re wondering whether this could be a reasonable next step for your condition, the next step is a specialist consultation. That conversation is where we review your diagnosis, treatment history, and whether this option makes sense to consider. The goal is not to rush you into treatment. The goal is to determine whether you are an appropriate candidate.

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