A headache following a steroid injection, especially an epidural, can be an unwelcome side effect for many. While some headaches are mild and temporary, others can be severe and persistent, indicating different causes and requiring distinct approaches for relief. Understanding why you might have a headache is the first step toward effective management.
Types of Headaches from Steroid Injections
There are two primary types of headaches associated with steroid injections. Identifying which one you have is critical for choosing the right treatment strategy.
Post-Dural Puncture Headache (PDPH)
This is a specific type of severe headache that can occur after a spinal or epidural injection. It happens when the injection needle accidentally goes too far, puncturing the dura mater, the protective membrane surrounding the spinal cord, and causing cerebrospinal fluid (CSF) to leak.
- Key Characteristics: The headache is positional, meaning it is significantly worse when you sit or stand and improves when you lie down.
- Other Symptoms: It can be accompanied by neck pain, nausea, and changes in vision or hearing.
- Onset: Typically starts within 24-48 hours after the injection, but can sometimes appear later.
Non-Positional Headache
This type of headache is not dependent on your body position and can occur after any type of corticosteroid injection, not just spinal ones. Several factors can contribute to its development.
- Causes: It can be a side effect of the corticosteroid mimicking cortisol, which can lead to changes like elevated blood sugar (potentially causing a pounding headache in diabetic patients) or insomnia, which triggers migraines. Some patients also experience a temporary spike in pain in the days following the injection, known as a 'cortisone flare,' which can also manifest as a headache.
- Key Characteristics: This headache does not typically get better when lying down. It's often milder than a PDPH and may resemble a tension headache or a typical migraine.
Comparison of Headache Types
| Feature | Post-Dural Puncture Headache (PDPH) | Non-Positional Headache |
|---|---|---|
| Cause | CSF leak from accidental dural puncture during spinal/epidural injection. | Systemic effect of corticosteroids (e.g., blood sugar changes, insomnia, cortisone flare). |
| Severity | Often severe and incapacitating. | Typically milder, resembling a tension headache. |
| Positional | Worse when sitting or standing; relieved by lying flat. | Not affected by body position. |
| Onset | Usually within 24-48 hours. | Can occur within hours or days. |
| Additional Symptoms | Neck pain, nausea, visual changes. | Insomnia, flushing, increased blood sugar. |
How to Manage Headache Symptoms
Management strategies differ based on the type of headache. It's important to consult with your doctor before starting any treatment.
For Mild, Non-Positional Headaches
- Over-the-Counter Pain Relievers: Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can often provide relief. Always check with your doctor, as NSAIDs like ibuprofen can have blood pressure implications when combined with steroids.
- Rest: Take it easy and avoid strenuous activity in the days following the injection.
- Hydration: Drink plenty of fluids to help your body recover and manage the mild side effects of the steroid.
- Ice Pack: Applying a cold pack to the injection site or base of your neck can help with general pain and inflammation.
For Post-Dural Puncture Headaches (PDPH)
- Lie Down: Remain in a flat, lying position as much as possible. The pain should subside almost immediately when you are horizontal.
- Increase Hydration: Drink lots of fluids to help restore spinal fluid volume.
- Caffeine: Caffeine can constrict blood vessels in the brain, which helps relieve the headache caused by low CSF pressure. Caffeinated beverages like coffee or soda are recommended. In severe cases, IV caffeine may be administered in a medical setting.
- Epidural Blood Patch (EBP): If conservative treatments fail, your doctor may perform an EBP. This involves taking a small amount of your own blood and injecting it into the epidural space, where it forms a clot to seal the CSF leak. This procedure has a high success rate for severe or persistent PDPH.
When to Seek Medical Attention
While most post-injection headaches are not serious and resolve with time and conservative treatment, certain symptoms require immediate medical evaluation.
- Severe Positional Headache: If your headache is severe and significantly worsens when upright, it's crucial to report it to your doctor immediately, as it suggests a PDPH.
- Signs of Infection: Look for fever, increasing redness or swelling at the injection site, or a stiff neck, as these could indicate an infection.
- Neurological Changes: Any new or worsening neurological symptoms such as numbness or tingling in the arms or legs, dizziness, changes in vision, or loss of bowel or bladder control warrant immediate medical attention.
- Persistent Symptoms: If your headache does not improve after several days of at-home care, or if it's accompanied by severe nausea or vomiting, contact your healthcare provider.
Conclusion
Headaches are a possible side effect of steroid injections, and the appropriate response depends on the underlying cause. A positional headache, worse when standing and relieved by lying down, is characteristic of a dural puncture and requires specific treatment, including potential rest, hydration, caffeine, or an epidural blood patch. Non-positional headaches are generally milder and can be managed with over-the-counter pain medication, rest, and hydration. Always communicate with your healthcare provider about your symptoms, especially if they are severe or persistent, to ensure proper diagnosis and care.
