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.
Skin dimpling, deformation, shrinkage or subcutaneous atrophy of soft tissues at the area of steroid injection is not a common complication or side effect. This sometimes happens when the medication collects at the muscle or fatty layer of the skin and changes the consistency or contour of the tissues, resulting in skin dimpling. This effect may happen depending on the amount and solubility of the steroid injected. Among the various steroid drugs used, triamcinolone hexacetonide and triamcinolone acetonide are the most likely offenders, since they are the least soluble steroids often used. Doctors may opt for more soluble agents, such as betamethasone or dexamethasone which is preferred for injecting into soft tissues.
High dosages of oral corticosteroids taken daily for prolonged periods of time can have serious systemic side effects including bone loss ( osteoporosis), increased risk of infections and diabetes and cataracts, thinning of skin, stretch marks, increased facial/body hair growth, acne, fluid retention, weight gain with redistribution of fat (fat deposits on back and face, thinning of limbs), muscle weakness, decreased resistance to infections, stomach ulcers, mood swings, insomnia, suppression of the body's own production of cortisol, etc.