Ask a doctor on the topic of Neurology

Is it possible to have severe headaches after taking Prednisolone?

February 12, 2018 | 35,00 EUR | answered by Nadja Struß

Hello,

the following background information:

About 3 weeks ago, I had a severe cold which led to a middle ear infection. The middle ear infection then resulted in tinnitus, which was treated with Prednisolone (in addition to antibiotics). The following dosage schedule was applied:

30.01. 100mg
31.01. 100mg
01.02. 75mg
02.02. 75mg
03.02. 50mg
04.02. 25mg
05.02. 25mg
06.02. 25mg
07.02. 12.5mg
08.02. 12.5mg

Since 06.02., I have had severe headaches that are so extreme that at times I can't do anything and I feel almost nauseous from the pain. These headaches worsen throughout the day and peak in the evening/night. In the mornings after waking up, they are also bad, but improve throughout the morning. In the last few days, I had almost no headaches during the day, but in the evenings they were strong as usual. Today they are stronger in the mornings again. I try to help myself with Paracetamol, but it only works to a certain extent.

The only additional symptoms I have are heartburn and stomach burning, which are likely due to the cortisone and my previous gastritis. My neck also hurts slightly, as if it were tense, but movement is not restricted. There are hardly any symptoms left from the cold: no fever, cough, ear pain, only the nose is still slightly stuffy.

An MRI was performed earlier this year due to papilledema - with no findings. My general practitioner attributes the headaches to a "withdrawal" from the cortisone medication, but said it should be over within 3-4 days. It has now been 5 days.

Since my neurologist is unfortunately not available this week and my general practitioner couldn't really help me, I am reaching out to you for insights on whether these headaches could really be related to Prednisolone or if I should seek medical attention elsewhere. How should I proceed sensibly and what can I do independently to alleviate the headaches? Thank you.

Nadja Struß

Dear questioner,

Headaches after cortisone therapy are not a typical side effect, except perhaps through an increase in intracranial pressure that cortisone can trigger (rarely). However, it is unlikely that your headaches are related to cortisone therapy, as the therapy was only carried out for 10 days at moderate doses.

Neck pain could also be a trigger. You should consult an internist or general practitioner to investigate your stomach complaints as well. The fact that you are unable to control your pain with paracetamol alone is reason enough to see a doctor.

Tapering off cortisone treatment is only necessary after a 3-week therapy in very small steps. "Withdrawal symptoms" from abrupt discontinuation can lead to adrenal insufficiency, but this is not typically characterized by headaches, but rather by severe gastrointestinal symptoms, low blood pressure, and fever.

Best regards,

Nadja Struß