Can a cortisone shot cause a headache?

October 9, 2025 •

4 min read

While cortisone injections are often used to provide localized anti-inflammatory relief, headaches are a known, albeit less common, side effect. For most joint injections, a headache is a temporary systemic reaction, but for epidural shots, a rare complication known as a post-dural puncture headache (PDPH) can occur.

Quick Summary

Headaches are a known side effect of cortisone injections, stemming from systemic steroid effects or, rarely after spinal procedures, a post-dural puncture headache. Duration and management vary depending on the specific cause.

Key Points

Known Side Effect: Headaches are a known, though not universally common, side effect of cortisone injections due to systemic effects or sleep issues.
PDPH Risk: A rare but distinct cause, especially after an epidural steroid injection, is a post-dural puncture headache (PDPH) from a CSF leak.
Positional Headaches: A key differentiator for PDPH is a headache that worsens when sitting or standing and improves when lying down, caused by changes in intracranial pressure.
Systemic Triggers: Other factors like elevated blood sugar, fluid retention, or insomnia following the injection can also trigger headaches.
Symptom Duration: General steroid-induced headaches are often temporary, resolving in a few days, while PDPH can persist longer.
Immediate Action: Contact your doctor if you experience a severe, persistent, or positional headache, especially if accompanied by fever or neurological symptoms.

Cortisone injections are a powerful medical tool used to reduce inflammation and pain in targeted areas, such as joints, tendons, and the spine. While they are generally safe, like any medical procedure, they carry a risk of side effects, with headaches being one of the possible, though less frequent, outcomes. Understanding the potential causes, from systemic reactions to rare procedural complications, can help patients and clinicians better manage and differentiate the issue.

Why a Cortisone Shot Might Cause a Headache

There are several distinct mechanisms by which a cortisone injection can lead to a headache. The cause depends on the type of injection and an individual's unique physiological response.

Systemic Side Effects

Sleep Disturbances: Corticosteroids can cause insomnia or trouble sleeping, which is a known trigger for headaches or migraines in some individuals. For some, this effect can feel like a "hyper" sensation or excessive energy.
Blood Sugar Fluctuations: Cortisone can temporarily raise blood sugar levels, especially in people with diabetes. Symptoms of hyperglycemia, such as headache, fatigue, and blurred vision, can sometimes occur.
Fluid and Electrolyte Shifts: Cortisone plays a role in regulating the body's water and electrolyte balance, and the injection can cause temporary fluid retention and sometimes elevate blood pressure. These changes in blood pressure or fluid balance can lead to a headache.
Cortisone Withdrawal: As the effects of the steroid begin to wear off, some patients can experience a form of steroid withdrawal, which may manifest as a headache along with other non-specific symptoms like fatigue.

Post-Dural Puncture Headache (PDPH)

A much rarer, but more specific, cause of headache occurs after an epidural steroid injection (ESI), a procedure often used for back pain.

What it is: During an ESI, the needle delivers medication to the epidural space surrounding the spinal cord. If the needle accidentally punctures the dura, the outer membrane of the spinal cord, it can cause a leak of cerebrospinal fluid (CSF).
Mechanism: The CSF leak reduces pressure around the brain. When a person sits or stands, the brain sags slightly, pulling on pain-sensitive nerves and causing a severe headache.
Key Characteristics: The hallmark symptom of a PDPH is a headache that worsens significantly when upright and is relieved by lying down.
Incidence: While scary, a PDPH is uncommon, occurring in less than 1% of ESIs with standard needles.

Comparison of Headache Types Post-Cortisone Injection

To help differentiate between the types of headaches, the following table compares key characteristics:


Feature	Systemic Steroid Headache	Post-Dural Puncture Headache (PDPH)
Injection Type	Any cortisone injection (e.g., joint, shoulder)	Specifically follows an epidural steroid injection (ESI)
Onset	Can occur within hours or up to a few days post-injection	Typically begins 24 to 48 hours after the ESI, but can be up to 12 days
Symptom Pattern	Varies, can be non-positional; often triggered by related side effects like insomnia or high blood sugar	Distinctly positional; worsens when sitting or standing and improves when lying flat
Associated Symptoms	May include fatigue, flushing, mood changes, or blood sugar issues	May include neck pain, nausea, vision changes, or tinnitus
Duration	Usually temporary, lasting 1 to 3 days	Can last for days or weeks but often resolves with time and conservative management

How to Manage a Headache After a Cortisone Shot

For a milder headache caused by systemic effects, simple strategies can be effective.

Rest: Take it easy for a day or two after the injection. Adequate rest can help your body recover.
Hydration: Drink plenty of fluids, especially if the headache is related to mild dehydration or electrolyte shifts.
Pain Relievers: Over-the-counter medications like acetaminophen can help manage the pain. Check with your doctor before taking NSAIDs like ibuprofen, especially if you have high blood pressure or other risk factors.
Caffeine: For PDPH, caffeine can help by increasing blood pressure and stimulating CSF production. This can be consumed through coffee, tea, or soda.

When to Seek Medical Attention

While most headaches after a cortisone shot are temporary and harmless, certain symptoms warrant immediate medical evaluation.

Positionality: A severe headache that is noticeably worse when you sit or stand and improves when you lie down could indicate a PDPH.
Persistence: If a headache lasts for more than a few days, especially if it doesn't improve with self-care measures, contact your provider.
Red Flags: Seek immediate medical care if your headache is accompanied by:
- Fever, stiff neck, or rash.
- Confusion, seizures, or double vision.
- Weakness, numbness, or trouble speaking.
- Signs of infection at the injection site, such as increasing pain, redness, or swelling.

Conclusion

Yes, a cortisone shot can cause a headache, but the cause and severity vary based on the injection type and individual response. For localized injections, a headache is often a mild, transient systemic effect. For spinal injections, a rare but distinct and severe postural headache (PDPH) is possible. Most cases are manageable with conservative measures, but it is crucial to monitor symptoms and contact your healthcare provider if you experience a persistent, severe, or positional headache or any other concerning symptoms. For more detailed information on cortisone shot side effects, you can visit the Cleveland Clinic's health library. Always discuss the risks and benefits with your doctor before proceeding with any medical treatment.

Frequently Asked Questions

Headaches are a known side effect of cortisone shots, but they are not the most common one. Many people do not experience this side effect. It can be a temporary systemic reaction to the steroid or, less commonly, related to the injection site.

A PDPH is a rare but severe headache that can occur after an epidural steroid injection if the needle accidentally punctures the dura, the membrane surrounding the spinal cord, causing cerebrospinal fluid (CSF) to leak. The key symptom is that the pain is worse when sitting or standing and improves when lying down.

The duration depends on the cause. Systemic steroid-induced headaches are usually temporary, often resolving within 1 to 3 days. A PDPH, however, can last for days or weeks but typically improves with conservative management.

For mild headaches, strategies include resting, staying well-hydrated, and using over-the-counter pain relievers like acetaminophen. For a potential PDPH, caffeine, lying flat, and increased fluid intake are often recommended.

Yes, a cortisone shot can temporarily increase both blood pressure and blood sugar levels, which can sometimes contribute to a headache. This effect is especially important for individuals with diabetes to monitor.

You should contact your doctor if the headache is severe, persistent, or worsening. Seek immediate medical care if you experience a headache accompanied by fever, a stiff neck, confusion, seizures, or double vision.

A 'cortisone flare' is a temporary increase in pain and inflammation at the injection site that can occur shortly after the procedure. While not a direct cause of a headache, the stress and discomfort could be a contributing factor for some sensitive individuals.

Some risk factors, like accidental dural puncture during an ESI, are unavoidable. However, maintaining good sleep hygiene, staying hydrated, and managing underlying conditions like diabetes can help minimize systemic headache triggers.