Your first TMS session at High Peaks TMS is different from every session that follows. It includes your motor threshold calibration — the individualized neurophysiological measurement that ensures every subsequent treatment is accurately dosed to your specific brain anatomy. Here is exactly what to expect, minute by minute.
Before You Arrive
No special preparation is required. Eat normally. Take your regular medications as prescribed. Avoid excessive caffeine on the morning of your first session if you are caffeine-sensitive — not because it affects TMS, but because some patients find that high caffeine intake increases scalp sensitivity.
Remove any hair products (gel, spray, wax) from the area of the scalp where the coil will be placed — typically the left side of the crown. These products can interfere with coil contact. Otherwise, arrive as you normally would for any medical appointment.
Bring: Photo ID, insurance card, your medication list, and any prior psychiatric records if you haven't already provided them.
Plan for: Approximately 60–75 minutes for your first session (versus 20–37 minutes for all subsequent sessions).
Session 1 (calibration): 60–75 minutes. Sessions 2–36: 20–37 minutes. You will leave immediately after each session and can drive yourself home.
Minute by Minute: Your First Session
Arrival and positioning (0–10 minutes). You will be seated in a reclining clinical chair — similar to a dentist's chair in configuration but more comfortable. The chair reclines to a position that allows the TMS coil to be placed against the left side of your scalp without strain on your neck or back.
Motor threshold calibration (10–30 minutes). This is the step unique to your first session. Your clinician places the NeuroStar coil over the motor cortex — the brain region controlling hand movement — and delivers brief test pulses at increasing intensities until your thumb visibly twitches. The intensity that reliably produces this movement is your motor threshold. Your treatment intensity is then set as a fixed percentage of your motor threshold — ensuring that stimulation is calibrated to your individual neurophysiology rather than a population average.
Coil repositioning and treatment (30–60+ minutes). Once your motor threshold is established, the coil is moved to the left dorsolateral prefrontal cortex — the treatment target for depression. The treatment session begins. You will hear a rhythmic clicking sound and feel the tapping sensation of the magnetic pulses on your scalp. You are free to listen to music, watch television if available, or simply close your eyes.
Post-session (final 5 minutes). After the session ends, you sit upright, gather your belongings, and leave. There is no recovery period. Your cognition, motor function, and reaction time are completely unaffected. Drive yourself home, return to work, or go directly to your next obligation.
What You Will Feel
The tapping sensation varies by individual but is generally described as mild to moderate — rated 2–4 out of 10 on a pain scale by most patients in the first session. It is not painful in the clinical sense, but it is noticeable. This sensation diminishes significantly over the first several sessions as the scalp adapts to the stimulation pattern.
Some patients experience mild facial muscle twitching — particularly in the jaw or cheek — during the calibration phase. This is a direct physiological effect of the magnetic field on nearby motor circuits and is completely harmless.
The first session is the most uncomfortable. By session 5–7, the scalp adapts and most patients describe the tapping as barely noticeable. Scalp discomfort is the most common reason patients are hesitant — and the most common reason they're relieved once they experience it.