The Link Between Steroid Injections and Headaches
While steroid injections are highly effective at reducing inflammation and relieving localized pain, they are not without potential side effects. A throbbing head after a procedure might leave you asking, can steroid injections cause headaches? The answer is a definitive yes, with several possible culprits depending on the type of injection and individual patient factors. Understanding the different mechanisms can help you identify the cause and seek appropriate treatment.
Systemic Side Effects and Generalized Headaches
Even when injected locally into a joint, such as the knee or shoulder, some of the corticosteroid medication can be absorbed systemically into the bloodstream. This can lead to a range of side effects that affect the entire body. A temporary, generalized headache that is not positional (meaning it doesn't change with head position) is one such possibility. The steroid can also cause temporary insomnia or blood sugar fluctuations, both of which can trigger a headache. These types of headaches are generally short-lived and resolve on their own as the medication wears off.
Post-Dural Puncture Headache (PDPH) Following an Epidural
For those who receive an epidural steroid injection (ESI) for back or neck pain, a specific and more severe type of headache is a rare but possible complication. An ESI involves injecting the steroid into the epidural space, the area just outside the protective sac (dura) that surrounds the spinal cord. If the needle inadvertently punctures this sac, cerebrospinal fluid (CSF) can leak out. This fluid leak decreases the pressure around the brain, causing it to sag slightly when a person sits or stands, stretching surrounding nerves and causing a distinct positional headache.
Key characteristics of a PDPH include:
- Positional pain: The headache is typically severe when sitting or standing and significantly improves or resolves when lying down.
- Delayed onset: It may not appear immediately but can start anywhere from 24 to 48 hours, or even up to 12 days, after the procedure.
- Other symptoms: Accompanying symptoms can include nausea, dizziness, sensitivity to light, and ringing in the ears.
Other Potential Contributors
Besides systemic effects and CSF leaks, other factors can cause or contribute to headaches after a steroid injection. For instance, increased blood pressure is a known side effect that can trigger headaches. While a less common cause, some individuals may also experience headaches as part of a more generalized nervous system response, leading to symptoms like flushing and sleeplessness.
Comparison of Headache Types After Steroid Injections
| Feature | Systemic Headache (Non-Positional) | Post-Dural Puncture Headache (PDPH) |
|---|---|---|
| Cause | Systemic absorption of the steroid, insomnia, or blood sugar fluctuations. | Accidental puncture of the dura during an epidural injection, causing a cerebrospinal fluid (CSF) leak. |
| Timing | Typically occurs within 1–5 days after the injection. | Starts within 24–48 hours, but can be delayed up to 12 days. |
| Pain Characteristics | Generalized, steady, or throbbing pain that is not dependent on body position. | Severe pain when sitting or standing; relieved when lying down. |
| Associated Symptoms | Facial flushing, sleeplessness, mood swings, increased appetite. | Nausea, dizziness, sensitivity to light, ringing in the ears. |
| Treatment | Rest, hydration, over-the-counter pain relievers. | Rest, fluids, caffeine intake, and, in severe cases, an epidural blood patch. |
What to Do If You Get a Headache
For a mild headache suspected to be from systemic steroid effects, home care is often sufficient. Ensure you are well-hydrated, get adequate rest, and use over-the-counter pain medication like acetaminophen, but consult your doctor before using NSAIDs like ibuprofen, especially if you have other health conditions.
If you have received an epidural injection and suspect a PDPH, contact your doctor immediately. They can advise on initial management steps, such as staying hydrated and drinking caffeinated beverages. For persistent or severe cases, a specialized procedure called an epidural blood patch may be required to seal the leak.
When to Seek Immediate Medical Care
While many side effects are benign, certain symptoms require immediate medical attention. Contact your healthcare provider or seek emergency care if you experience:
- A severe headache that worsens when you sit or stand and improves when you lie down.
- A fever of 101°F or higher.
- Signs of infection at the injection site (increased swelling, redness, severe pain).
- Sudden weakness, numbness, or tingling in your arms or legs.
- Changes in vision or hearing.
Conclusion
While a headache is a known and potential side effect, most instances are mild and temporary. Severe, positional headaches, such as a post-dural puncture headache, are rare but can occur after epidural injections and require prompt medical attention. If you experience a headache following a steroid injection, monitor your symptoms and communicate with your healthcare provider to determine the appropriate course of action.
For more information on the side effects of cortisone shots, you can visit a trusted resource such as the Cleveland Clinic.
