As with most treatments, cortisone injections can have side effects. These can include various kinds of headaches.

Cortisone is a type of molecule known as a corticosteroid, or steroid for short. Cortisone injections help relieve inflammation in your joints, muscles, or connective tissue. They can be useful in treating conditions like:

  • tendonitis
  • carpal tunnel syndrome
  • back pain
  • arthritis

The most common side effect of a cortisone injection is pain and swelling where the injection was given. Other side effects include facial swelling, increased appetite, and high blood sugar.

Headaches are also a known side effect of cortisone injections. And a steroid injection to the spine, known as an epidural steroid injection (ESI), can cause a specific type of headache called a post-dural puncture headache (PDPH).

Let’s review the connection between cortisone injections and headaches, including what causes them and how to relieve the pain.

Headaches are a known side effect of cortisone shots but it’s not always clear what causes the headache. Cortisone shots can lead to difficulty sleeping (insomnia), which may cause a headache or migraine episode. The injection can also temporarily raise your blood sugar levels, which could in turn, also cause a headache.

A headache can also occur following an ESI. An ESI delivers the steroid medication directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space.

Sometimes, a doctor will insert the needle a bit too far when administering the steroid medication. If the needle punctures the outer membrane of the spinal cord (dura), spinal fluid can leak into the spine. The result is an epidural headache, also known as a PDPH or spinal headache.

The onset of headache after an ESI is usually within 24–48 hours but there have been reports of the headache starting 12 days after the procedure.

The headache typically worsens with sitting or standing and improves with lying down.

In a recent study of 1,708 people who received a corticosteroid injection to the ankle joint, only 5.8% of people experienced side effects in general. The most common side effect was pain and swelling at the injection site (post-injection flare), followed by skin reactions. No headaches were reported in the study. This suggests headache may be a less common side effect of cortisone shots to a joint.

A PDPH or a spinal headache following an ESI is also uncommon. Research suggests they occur in less than 1% of people receiving an ESI, but this depends on the size of the needle used and other factors. With a larger needle, the incidence of PDPH increases to nearly 36%.

Treatment for a headache depends on its severity but may include:

For a severe spinal headache, your doctor may recommend an epidural blood patch. This involves drawing blood from one of your veins and then injecting it into the epidural space.

This treatment is up to 98% effective.

Other common side effects of cortisone shots include:

Rarer but potentially serious side effects include:

Learn more about the side effects of cortisone injections.

Cortisone injections can cause a range of side effects but not everyone who gets a cortisone shot will experience side effects. Before your appointment, speak with your doctor about the risks and benefits of a cortisone shot.

Why do I have a headache after a cortisone shot?

Headaches are a known side effect of cortisone shots. Cortisone shots can also make it difficult to sleep and raise your blood sugar levels, which may also contribute to a headache.

Are headaches normal after steroid injections?

Headaches are normal after a steroid injection but aren’t the most common side effect.

If you’ve received a steroid injection to the spine, a headache may indicate you have a PDPH, also known as an epidural headache. A PDPH is a rare, but treatable complication of a steroid injection to the spine.

How long do side effects last after a cortisone injection?

Common side effects of cortisone injections, like pain and swelling at the injection site, usually subside after a few days.

In rare cases, repeated cortisone injections can lead to long-term complications, like diabetes. Repeated steroid injections to the same area of the body may also result in permanent bone loss or damage to the cartilage.

Cortisone injections have strong anti-inflammatory effects and can help reduce pain and improve the function of your joints, muscles, or connective tissue.

But steroid injections can also cause side effects, including pain and swelling at the injection site, insomnia, increased blood pressure and blood sugar, and headaches. Headaches are also a known side effect of epidural steroid injections.

If you have concerns about getting cortisone injections, speak with your healthcare professional, who can help you weigh their benefits and risks.