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Factors associated with treatment-emergent headache occurrence following RTMS to non-motor areas and the impact on treatment outcomes: a retrospective study

Year: 2026

Type: article

Abstract: Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is an FDA-approved, non-invasive treatment for Major Depressive Disorder (MDD). rTMS has a favorable safety profile, however, headaches are a common side effect. It is unclear which patients may be at greatest risk for headache, which device parameters might be associated with headache, and whether occurrence of headaches during rTMS affects eventual treatment outcome. Methods: This retrospective study analyzed clinical records from 938 patients who received rTMS treatment between 2017 and 2023. Patients were categorized based on whether they reported treatment-emergent headaches during the first 15 sessions. We assessed associations between headache occurrence and stimulation parameters (motor threshold, stimulation intensity), as well as patient characteristics (age, gender, baseline depression severity). Depression outcomes were measured using the Inventory of Depressive Symptomatology IDS. Results: Treatment-emergent headaches occurred more frequently in younger patients (p = 0.03) and women (p = 0.001), with no differences in headache occurrence observed across stimulation parameters. Patients who reported headaches had higher baseline depression scores (p = 0.0008) and maintained slightly elevated symptoms throughout treatment. Headache occurrence did not significantly affect overall clinical response rates but was associated with improved treatment retention. Conclusions: Treatment-emergent headaches during rTMS appear more closely linked to patient specific characteristics, such as age, gender, and depression severity rather than stimulation parameters. While the occurrence of headaches is common, they had no impact on clinical outcomes and can improve retention if correctly managed. We recommend providing individualized patient support during the early phase of treatment to improve adherence and enhance patient experience.

Source: Frontiers in Psychiatry

DOI: 10.3389/fpsyt.2026.1814081