Can TMS Therapy Cause Vertigo?
Yes, TMS therapy can cause vertigo, though it appears to be an uncommon adverse effect reported primarily as transient dizziness rather than true rotatory vertigo.
Evidence for TMS-Associated Vertigo
The available evidence documents vertigo/dizziness as a potential side effect of TMS:
Case report evidence demonstrates that diagnostic transcranial magnetic stimulation can trigger benign paroxysmal positional vertigo (BPPV), with one documented case of a 44-year-old healthy female developing left-sided BPPV 10 hours following standard bilateral diagnostic TMS 1.
The proposed mechanism involves TMS potentially causing detachment of otoconia from the utricular matrix, similar to other known triggers like head trauma and inner ear diseases 1.
In a long-term repetitive TMS (rTMS) treatment case for tinnitus, transient dizziness occurring 30 minutes after treatment was documented as an adverse event, though it resolved spontaneously 2.
Clinical Context and Frequency
The occurrence of vertigo with TMS appears to be:
Rare and typically transient when it does occur, based on limited case reports in the literature 1, 2.
More commonly described as "dizziness" rather than true rotatory vertigo (the spinning sensation characteristic of vestibular disorders) 2.
Not listed among the major common adverse effects in consensus papers on TMS safety, which focus more on headache, scalp discomfort, and seizure risk 3.
Distinguishing True Vertigo from Dizziness
It is critical to differentiate between true vertigo and other forms of dizziness:
True vertigo is defined as a false sensation of self-motion (rotatory spinning) or movement of the environment when neither is occurring 3.
Dizziness represents a sensation of disturbed spatial orientation without false or distorted sense of motion 3.
Most TMS-related reports describe transient dizziness rather than sustained rotatory vertigo 2.
Clinical Implications
When TMS causes vestibular symptoms:
BPPV should be considered if positional vertigo develops following TMS, as it can be effectively treated with canalith repositioning maneuvers 1.
Symptoms are generally self-limited and resolve without intervention in most documented cases 2.
The risk appears lower than with established vestibular disorders like Ménière's disease, vestibular migraine, or vestibular neuritis 3.
Emerging Therapeutic Use
Paradoxically, rTMS is being investigated as a treatment for chronic vestibular disorders, with studies showing promise for conditions like mal de debarquement syndrome, though methodological limitations warrant caution 4.