Headache after cortisone therapy

Question

Dear Expert Team,

for some time now, I have been noticing that, after cortisone therapy, I get a headache that lasts for weeks. It usually goes away after about for weeks, but it is unbearable without pain killers. The initial dosage is usually 20 mg and the headache slowly starts at 10 mg and becomes really intense after the therapy. Could it perhaps be potassium deficiency? Also, I am always very shaky along with the headache. Therefore, last time a head CT was performed, but nothing was found. I hope you can help me or can give me some advice!

Kind regards,
a 34-year-old CF patient

Answer

Hello,

cortisone as well as the artificial corticoids derived from it, which are usually used due to their greater anti-inflammatory effect, also have a (mostly unwanted) impact on the salt balance. One can often see this already from the edemas (water incorporations) that emerge during treatment. They keep sodium in the body, which absorbs water, and this one then sees as edemas. One can also recognize it from a rising blood pressure (even if there are no edemas yet). Elevated blood pressure can lead to headache. However, this group of drugs also modifies the glycometabolism towards higher sugar values or lower sugar tolerance – and elevated blood sugar can also lead or contribute to headache.

Theoretically, potassium or magnesium deficiency can occur under therapy but should be easy to count out; it is rather unusual, however, that your ailments get “really bad” only after the corticoids are discontinued.

These are just the most frequent side effects of a treatment with cortisone and its derivatives. Generally, one always has to weigh the benefits against the risks of a treatment. Since you do not write why cortisone is being applied time and again in your case and whether there are any risks of salt deficiency or permanent imbalance of body salts, one can only help little from here. But such intense headaches have to make one think about alternatives, perhaps trying to use a different drug with a slightly narrower spectrum of effects. That, however, is something only your doctor can discuss with you, of course.

Kind regards,

Prof. D. TOF Wagner

08.12.2008