This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.
The severity of these complications correlates with the dosage, duration of use, and the potency of the steroid prescribed. While the incidence of steroid-induced myopathy does not appear to be directly related to the dosage of steroid prescribed nor the duration of use, it appears to be more prevalent with the use of steroids containing a 9-alpha fluorine configuration, such as triamcinolone (Aristocort®). The relationship between hypertensive side effects and the duration of therapy is also not very clear; steroids should be prescribed with greater caution in the elderly, in those individuals with known hypertension, and when compounds with greater mineralocorticoid properties are prescribed. As hyperglycemia is a well-known complication of corticosteroid use, oral steroids should be prescribed with caution in the diabetic population.