Traumatic brain injuries may cause much more than headaches and memory problems.
Patients can also experience depression, anxiety, post-traumatic stress, ringing in the ears, disrupted sleep, and persistent pain. These symptoms may continue even when routine imaging does not provide a clear explanation.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Gilbert Mbeo about transcranial magnetic stimulation, commonly called TMS, and the importance of identifying sleep problems after a brain injury.
What Is Transcranial Magnetic Stimulation?
Transcranial magnetic stimulation is a noninvasive treatment that uses pulses of magnetic energy to stimulate targeted areas of the brain.
TMS was originally used as a research tool to study brain activity and neurological circuits. Over time, it became a clinical treatment for certain mental health conditions.
It is now FDA-approved for treatment-resistant depression and is being explored for additional neurological and psychiatric symptoms.
Dr. Mbeo discussed its emerging role in treating some of the consequences associated with mild and moderate traumatic brain injuries.
How TMS Targets the Brain
Before treatment begins, the provider must determine which area of the brain should receive stimulation.
This may involve a process known as brain mapping.
The provider identifies the location of important brain regions and selects a treatment protocol based on the patient’s symptoms. Certain approaches may also use quantitative EEG testing or MRI-guided mapping to improve accuracy.
Once the treatment area is identified, a device positioned near the patient’s head delivers repeated magnetic pulses.
The goal is to influence brain circuits that may not be functioning normally after the injury.
TMS Is Not Electroshock Therapy
Patients sometimes confuse TMS with electroconvulsive therapy.
Dr. Mbeo emphasized that they are not the same treatment.
TMS uses magnetic pulses rather than electrical current delivered through the brain. It does not generally require anesthesia, and the patient remains awake during the session.
A typical session may last approximately 30 minutes, although the length can vary.
Some patients describe a tapping sensation on the scalp while the machine is operating.
Which TBI Symptoms May Be Treated?
The role of TMS in traumatic brain injury care is still developing.
Dr. Mbeo discussed several symptoms that may potentially respond to targeted stimulation, including:
- Depression
- Anxiety
- Post-traumatic stress
- Persistent headaches
- Sleep disturbances
- Tinnitus
- Mood regulation problems
The treatment is not designed to reverse every effect of a traumatic brain injury.
Instead, it may help reduce selected symptoms by stimulating the brain networks connected to them.
Treating Depression and Emotional Changes
Changes in mood are common after traumatic brain injuries.
A patient may experience new depression, increased anxiety, emotional instability, or symptoms of PTSD. Existing mental health conditions may also become worse.
TMS is already an established option for some patients with treatment-resistant depression.
Dr. Mbeo explained that similar brain circuits may be targeted when mood symptoms occur after a traumatic brain injury.
The treatment protocol and number of sessions may vary according to the patient’s diagnosis and response.
Can TMS Help Ringing in the Ears?
Tinnitus is the perception of ringing, buzzing, pulsing, or another sound when no external source is present.
For some brain injury survivors, tinnitus becomes constant and interferes with sleep, concentration, and quality of life.
Traditional treatments do not always provide relief.
Dr. Mbeo discussed specialized TMS protocols intended to reduce the severity or aggravation caused by persistent tinnitus.
Some patients may begin noticing changes after several sessions, although results differ and improvement cannot be guaranteed.
Addressing Post-Traumatic Headaches
Persistent headaches are among the most common complaints after a concussion or traumatic brain injury.
These headaches may resemble migraines or develop into daily pain that does not respond well to standard medication.
Dr. Mbeo explained that TMS protocols may be used to target neurological circuits connected to headache symptoms.
Some patients report improvement after only a few sessions, while others need a longer course of treatment.
Because post-traumatic headaches can have several causes, patients still need a full evaluation of the neck, nerves, vision, medications, sleep, and other possible contributors.
How Many TMS Sessions Are Needed?
The number of treatments depends on the symptom being addressed and the individual patient.
Dr. Mbeo discussed treatment courses ranging from approximately 10 sessions to more than 30.
Some headache patients may notice improvement within the first few sessions.
Patients receiving TMS for depression may require a longer treatment course before meaningful changes become apparent. Dr. Mbeo noted that some clinical literature involving mood disorders shows improvement after approximately 20 sessions.
Tinnitus protocols may also involve around 10 sessions, with some patients noticing changes around the midpoint.
These are general observations rather than guaranteed timelines.
Who May Not Be a Candidate?
TMS is noninvasive, but it is not appropriate for everyone.
Dr. Mbeo discussed potential contraindications such as certain implanted metal devices, clips, stents, pacemakers, or uncontrolled seizure disorders.
The exact risk depends on the location and type of device or medical condition.
Before treatment, the provider should review the patient’s medical history, implanted hardware, medications, and seizure risk.
Appropriate patient selection and brain mapping are important parts of delivering treatment safely.
Sleep Problems Are Often Missed
Sleep disruption is one of the less visible consequences of traumatic brain injury.
Patients may not mention it because they do not realize it could be connected to the accident.
They may have trouble falling asleep, wake repeatedly, become unusually sensitive to sound, or feel exhausted after spending the entire night in bed.
Dr. Mbeo stressed the importance of asking patients directly about their sleep before and after the injury.
A person who slept normally before the accident and developed insomnia afterward may not recognize the connection until a provider asks specific questions.
Measuring Sleep Difficulties
Providers do not have to rely only on a general question such as, “Are you sleeping well?”
Dr. Mbeo discussed standardized tools that can help evaluate sleep quality and daytime sleepiness.
These include the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index.
The questionnaires may help identify:
- Difficulty falling asleep
- Frequent nighttime waking
- Daytime exhaustion
- Poor sleep quality
- Lack of restorative sleep
- Changes from the patient’s previous sleep pattern
Standardized screening can provide a clearer picture of how severely sleep has been affected.
Why Brain Injuries Disrupt Sleep
Sleep changes after a traumatic brain injury may result from several overlapping problems.
Pain can make it difficult to find a comfortable position. Anxiety or PTSD may keep the nervous system on high alert. Headaches and tinnitus may prevent relaxation.
The injury may also disrupt neurotransmitters and the body’s circadian rhythm, which regulates the sleep-wake cycle.
This means sleep problems should not automatically be treated as poor habits or a lack of effort.
They may reflect neurological and biochemical changes caused by the injury.
Sleep Supports the Brain’s Cleaning System
During sleep, the glymphatic system helps clear waste products from the brain.
Dr. Mbeo described it as the brain’s cleaning or sewer system.
When sleep is consistently disrupted, this waste-removal process may not function as effectively. Materials that would normally be cleared may remain in the brain longer.
Poor sleep may then contribute to memory problems, concentration difficulties, fatigue, mood changes, and reduced daily function.
Dr. Mbeo also discussed concerns about the possible long-term relationship between chronic sleep disruption and neurodegenerative problems.
The transcript does not establish that every patient with poor sleep will develop those conditions, but it emphasizes why persistent sleep issues deserve medical attention.
Poor Sleep Can Look Like Cognitive Decline
A patient may report that they constantly lose items, forget why they entered a room, or need written lists for tasks they previously handled without difficulty.
These symptoms may be directly related to the brain injury.
They may also be worsened significantly by sleep deprivation.
When the brain does not receive restorative sleep, attention and memory often suffer. That can make the patient feel as though their cognitive abilities are continuing to decline.
Evaluating sleep alongside memory and concentration may help providers understand why the patient is struggling.
TMS and Sleep Improvement
Dr. Mbeo said some patients report better sleep after only a few TMS sessions.
They may find it easier to fall asleep, stay asleep, or wake feeling more rested.
This observation does not mean TMS is guaranteed to treat insomnia or that it is appropriate for every patient with sleep difficulties.
Sleep problems can have many causes, and treatment should address the specific reason they are occurring.
However, improved sleep may be one meaningful benefit for selected TBI patients receiving TMS for other neurological or mood-related symptoms.
A Targeted Approach to Brain Injury Care
The appeal of TMS is that it offers a targeted, non-medication-based approach for symptoms that can be difficult to treat.
It may be especially valuable for patients who have not improved with standard medications or who want to avoid adding more prescriptions.
However, TMS should still be viewed as one part of a broader treatment plan.
Brain injury care may also include:
- Neurological evaluation
- Headache treatment
- Sleep assessment
- Mental health care
- Vestibular rehabilitation
- Vision therapy
- Physical therapy
- Cognitive rehabilitation
- Medication when appropriate
The treatment must be based on the patient’s individual symptoms, examination findings, and health history.
TMS is an emerging option that may provide relief for selected patients, but careful diagnosis and appropriate treatment planning remain the foundation of recovery.
More Podcasts – https://www.shanesmithlaw.com/podcast/
In Pain? Call Shane!
(980) 999-9999
Do you need an attorney? https://hubs.li/Q04fHBBj0
Been in a Charlotte Car Accident? https://hubs.li/Q04hFzPw0
For more information order our free book!
Related Posts:
Emerging Hope for Post-Traumatic Headaches: Medications, Procedures & Neuromodulation
