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I had a cortisone injection in my knee today and now have a bad headache. Can the injection cause a headache or is this just a coincedence?? Thanks

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So funny, I just had one today and am now googling to see if it can cause a headache, because I got one literally, two minutes after the shot. Very foggy feeling too. Wondering if it's related?
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I received a cortisone injection for low back pain 6 hours ago, and just developed a headache. I never get headaches, so I'm thinking maybe there's a correlation.
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I have been getting cortisone injections every 3 months for over a year in my knees. Never had a head ache,When I got one in my shoulder I had an immediate headache that lasted for 3 days
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:-( My head has not stopped hurting since Thursday and now it is late Sunday, I had a cortisone injection in both knees and now my heard is pounding and I am so hot all the time. Usually I am the most cold blooded person there is and now I can't get cooled down and am not sleeping? Do you think the cortisone is the problem? :-( .
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I just got a cortisone injection in my knee yesterday and today I've had a horrific headache. I just found your post online because I wondered if this was an anomaly. Guess it's not. How long did your headache last?
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i hda knee injection 4 hrs ago and since that ive had a headache -i kno the steroid causes flushing. or the local anaesthetic thats also used can cause headache
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Googling to find out if cortizone can cause headaches. I never have headaches, but got a cortizone shot in my knee today and I have had a headache for a few hours. I'm going to take Advil.
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I was reading the messages and it seems that getting a headache after a shot in the knee is not uncommon. I got a shot yesterday morning and I still have a horriffic one. I never get headaches!
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had an injection in my knee this morning and have a mild, but unusal for me, headache..........advil and to bed and hopefully it will be gone
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I had a shot today for the first time in my knee and I got a headache too. Didn't last too long, but it was an odd one. The only problem now is it is 1am and I can't sleep. My eyes are tired but my thoughts are racing,,,,wondering if this is a side effect too ???
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CORTISONE INJECTIONS

Inflammation is a process in the body in which a joint (arthritis), bursa (bursitis), blood vessel (phlebitis),or nerve (neuritis, radiculitis, or sciatica) is swollen, tender, red, irritated and warm. There is often limited motion, either due to the pain itself or to swelling. Frequently, if one structure is inflamed, another adjacent structure also becomes involved(example: a tendinitis causes a bursitis or vice versa). A drug which decreases the redness, tenderness, swelling and warmth is called an antiinflammatory (literally translated: against inflammation).

There are two types of anti-inflammatory medicine. One is the non-steroidal antiinflammatory drugs (the so called NSAID'S). Aspirin is the prototype of this family and includes such well known medicines as Naprosyn, Advil, Motrin, Ibuprofen, Aleve and many others. The other is cortisone. It is usually
possible to find a nonsteroidal antiinflammatory drug which each person will tolerate. Unfortunately, some people have such sensitive stomach that they will not tolerate any of these and other measures may need to be utilized.

CORTISONE

Cortisone (its pill form is called prednisone) is an example of the most powerful class of antiinflammatory drugs, called steroids. Cortisone is the best anti-inflammatory available. Unlike the NSAID's, cortisone has no direct effect on pain. However, pain is usually decreased because swelling and irritation have been the cause of the pain. Cortisone is a steroid that your body makes every day. Although it is chemically related, it is different and has none of the effects of the "steroids" used by athletes to get bigger muscles.

Cortisone can be given as a pill or shot, but I usually do not give it in pill form except for very short periods of a week or two. Cortisone, when given in a pill form (called prednisone), has several problems. However, when multiple joints or multiple areas are involved, prednisone is sometimes the drug of choice. Fortunately, most of the serious side effects are only with long term use. One particularly severe complication which can occur with even short term use is avascular necrosis of the humeral or femoral heads. This is an extremely rare complication in which the ball parts of the shoulder and hip joints die. I have seen it in as short a time period as 6 weeks of Prednisone therapy. Fortunately, I have never seen it in the typical time course that we utilize it which is approximately two weeks. It can also cause aggravation of diabetes, stomach ulcers and, when used over prolonged periods of time, even osteoporosis.

ADVANTAGES AND DISADVANTAGES

Both cortisone and NSAID's can be very effective. The advantages of NSAID's and prednisone are that multiple areas can be treated (only rarely can more than two joints be injected with cortisone) and relief often begins within hours. Of course, no needle is necessary. However, pills must be taken 1 to 4 times per day for several weeks, and, of course, may cause intolerable stomach or other side effects.

Cortisone injections usually need be given only once, and essentially never cause stomach upset or other side effects, besides the pain of the injection. However, because cortisone injections take a few days to begin to work and 2-3 weeks to reach maximum improvement, in that early period, NSAID's are sometimes used anyway until the cortisone begins working.

There is approximately a 20% chance of an increase in pain the day after the injection. This is known as a "cortisone flare" and is almost always a good sign. This is poorly understood phenomenon which lasts only for 24 hours and has no significant meaning. It usually resolves spontaneously although rest, ice, Tylenol or aspirin will help you to "grin and bear it". It is my subjective opinion that people who have this pain flare-up almost always will get an excellent long term result. If after the Marcaine wears off and the pain returns to its normal level without the cortisone flair, there is no effect on your prognosis whatsoever. It still takes two to three weeks to reach maximum improvement.

CORTISONE INJECTIONS

Most of the side effects of prednisone can be eliminated by using cortisone injections. Most commonly this will be performed in a joint such as the knee. Cortisone injections work because a very small amount of medicine is put into a small area. When an injection is used, the medicine is delivered directly to the site that needs it and it is in a form that stays right there. Therefore, very little total medicine is used and the rest of the body sees very little. The net effect is a very high concentration. For instance, if a pill is used for your left knee, your right little toe gets just as much medicine as your left knee. Your right little toe does not need any medicine. However, a very large amount of total medicine must be used in order to get an adequate amount to your knee.

The total amount of cortisone injected is approximately the amount that your own body produces in 24 hours. This diminishes the side effects of the cortisone. Unfortunately, precisely because its effect is limited, cortisone is only good for the joint in which it is injected. Potentially, this creates problems if multiple joints are involved. Normally, no more than 2 joints are injected in one visit. Under special circumstances, I will occasionally inject 3. Another question is the frequency which you can receive Cortisone injections. My own rule of thumb is approximately 3 to 4 injections per year. If you can not get at least 10 to 12 weeks of relief out of an injection I do not believe it is worth while to continue receiving them. If your symptoms are improved for such a short period of time, other therapy should be instituted. Steroids frequently work well the first or second time. However, with multiple injections the effects frequently begin to diminish. It is rare that a person will achieve success for more than 4 or 5 injections regardless of how long relief lasts between injections.

Cortisone injections avoid most of the short and long term side effects of prednisone listed above. Cortisone injections do not affect your stomach, cause avascular necrosis and do not cause osteoporosis. They can rarely cause aggravation of diabetes in insulin dependent, sensitive individuals. However, this is a temporary problem and is easily compensated by increases of your daily Insulin for a few days.

When I give a cortisone injection, I mix a long acting local anesthetic called Marcaine with the cortisone. This should eliminate your pain for 6-8 hours. If your pain is temporarily eliminated, I know the cortisone is in the correct spot. There are two potential reasons for failure of a cortisone injection. One is that the cortisone is not strong enough and number two, that the cortisone was not placed in the correct area. By using the local anesthetic I know that when you leave the office, the cortisone is in the correct spot.

Cortisone injections, unfortunately, do not work right away. The cortisone injection takes 2-3 days to begin to work and approximately 2-3 weeks to reach maximum improvement. You may benefit from Aspirin, Tylenol or other medications such as Naprosyn, Motrin or Clinoril for a few days after the injection until the cortisone has had some chance to have an affect.

Epidural Cortisone Injections

In people with sciatica, NSAIDs are usually the first treatment. However, when they fail, cortisone can frequently be used. Sometimes, we used prednisone. However, many times we will give a cortisone injection just as if we were giving it in the joint.

The comparable mechanism for injecting cortisone in the spine is to perform an epidural cortisone injection. The spinal cord and nerves are covered by a double walled sac. This as analogous to a Thermos bottle. A myelogram involves putting a needle directly into the middle of the sac. This fills up the sac just as an arthrogram fills up a joint. The epidural cortisone injection inserts the cortisone into the space between the 2 walls. This is a potential space that has no fluid in it. Cortisone injected here stays and continues to work for a very long period of time. It has the same effect as an injection into a joint. A very small amount of cortisone has an extremely high concentration at its maximum point of effectiveness. Epidural Cortisone injections are usually a secondary line of treatment after conventional therapy with oral anti-inflammatories and exercises have failed.

The injection is performed just as if it was a myelogram. Antiseptic solution is utilized to clean you back followed by local anesthetic. The needle is then inserted into the space and the cortisone is injected. The Cortisone typically takes 2 or 3 days to begin to work and approximately 2 weeks to achieve maximum improvement. Especially if the initial response is good a second injection can be considered at a later date. Typically however, no more than 2 or 3 injections are performed over a short period of time.

Unfortunately there can be complications. The most common complications is a headache. This can be very severe but is typically totally relieved by lying down. The incidence of a headache can be minimized by resting quietly for 24 hours, primarily lying down. Drinking plenty of fluids also seems to minimize the problem. Avoid caffeine and alcohol for 24 hours after the injection! Occasionally the headache is persistent for more than 2 or 3 days. If this persists contact the office and we may have to perform a procedure called an Epidural Blood Patch. This is almost always successful in eliminating the headache. Extremely rarely you may have nausea, vomiting, fever, chills. You may also have a temporary development of new weakness or even develop unusual sensations in the legs. These are normally not significant and should be reported if they progress or persist more than 24 hours. Because it may take up to 2 weeks to receive maximum benefits, if you are already on oral anti-inflammatory agents, there may some benefit to continuing them during the transition time until the Cortisone can achieve full benefit. You should make a return appointment in the office in two weeks.

© G. Klaud Miller 7/2/00
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I got my first shoulder shot on wed mar.9 and had a pounding eye wincing headache since and it is now Sunday night. Also had very bad stomach ache first day only for about 6 hours. This is probably my 6th shot in 22 years, however last was in 2001.
Something is very different now with the additives to the shot as this my first time for any of this. Will see what doc says tomorrow. >:(
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I had my first steroid shot in my shoulder last Tuesday. The local provided some pain relief for about an hour. After that, my arm felt heavy, the joint felt much worse, and it had been plenty bad enough before the shot. By evening, I had a raging headache, pressure in my eyes like someone was pressing on them and all over pain to my skull like it would burst. I never get headaches. I also have experienced significant abdominal discomfort, pressure, pain, burning and belching. This is also not something that is normal for me. I fell less able to use my arm and without my new TENS (electrical stimulation device) I would be laying in bed crying. I told my ortho about the headache and she said I should tell my primary care doctor if it continues. She seemed to think this was unrelated to the injection. Had they told me I would feel this bad for this many days (so far 5) I wouldn't have been so anxious to try the procedure. Although they do say you might be more sore for a few days, no mention of this awful headache or stomach pain was discussed. I used ice packs on my shoulder the night of the shot and on my head for about three days. I am angry and upset that these issues are brushed aside as if we made them up or they are unrelated. How about some honesty? I sent the Orthopedic dr a link to these pages. It might be nice to know how long we have to suffer from the side effects while we wait for pain relief from the injection. I hope it makes a difference, but no matter how good I feel after this week of suffering, I won't allow another injection.
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I have had injections in my joints before and never had headaches it's 5 years since my last one and 24 hours ago i had injectios in both knees and have the most awful headache i was worried until i read other posts so thankyou everybody
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