Cortisol and pain: what is known about headaches, joint pain and sweating

Pain is not a main sign of too much or too little cortisol. A few pain types turn up on symptom lists, and research on cortisol and chronic pain is mixed. Most pain, headache and sweating has other causes, and the sources we use don’t tie them to a cortisol level.

Can high cortisol cause pain?

NIDDK’s list of Cushing’s syndrome symptoms includes weight gain, a round face, easy bruising, wide purple stretch marks and weak muscles. Pain is not on it. NIDDK does list bone loss and fractures among the complications.

In a 2019 questionnaire of 320 people with Cushing’s syndrome, only 3.1 percent listed pain among the symptoms they first noticed (Endocrine Connections, 2022). That survey was online and recall-based, so treat the figure as rough. It suggests pain is not usually the first thing people notice.

One fact helps explain the confusion. NIDDK says glucocorticoids, which are cortisol-like medicines, are often injected into a joint to treat pain. Cortisol itself helps reduce inflammation.

Can low cortisol cause pain?

NIDDK lists abdominal pain among the most common symptoms of adrenal insufficiency, with long-lasting fatigue, muscle weakness, loss of appetite and weight loss. Joint pain is among the other symptoms it lists. See low cortisol symptoms.

Muscle pain is reported too, but not in every case. In a small study of 60 people with primary adrenal insufficiency in Poland, 37 percent had muscular pains, which they mostly linked to exercise or infection and which eased with rest. The authors note that other sources put the figure at 13 percent and 36 percent, and that fibromyalgia was among the wrong diagnoses some patients had first (Int J Endocrinol, 2013).

Vomiting you can’t stop, fainting, or weakness so severe you can’t do your usual activities are different. They can mean an adrenal crisis, which needs urgent care. See adrenal crisis.

Chronic pain and cortisol: where studies conflict

Research on chronic pain, such as fibromyalgia, goes in both directions. A 2020 meta-analysis says activity in the stress system has been linked to the severity of long-lasting muscle and joint pain. It also says other clinical studies found the opposite: higher cortisol with lower pain, and lower cortisol with greater pain. Its own result was that much more work is needed to understand the true relationship between cortisol and widespread chronic pain in fibromyalgia (Diagnostics, 2020).

A 2023 review adds that low cortisol has been linked to fibromyalgia, chronic fatigue and chronic pain syndromes, but that these reductions are moderate and aren’t generally considered to be Addisonian insufficiency (Front Endocrinol, 2023). In plain words, a somewhat low cortisol in someone with chronic pain isn’t the same thing as adrenal insufficiency, and nothing here says that low cortisol causes the pain.

Do cortisol headaches exist?

We found no recognized “cortisol headache” in the sources we use. What they do say:

• MedlinePlus lists headaches among the things you may notice if you’re stressed for a long time. It doesn’t name cortisol.
• MedlinePlus lists headache among the symptoms of too much aldosterone, a different adrenal hormone.
• A small 2025 study of 21 people with migraine without aura and 30 without migraine found a larger cortisol rise after a drug challenge in the migraine group. The differences did not reach the usual statistical cut-off (P values of 0.14 and 0.07), so treat it as a lead, not a finding (Pain Reports, 2025).

Headaches have many causes. A new, severe or changing headache needs a clinician, whatever you suspect.

Hip and joint pain

NIDDK lists bone loss and fractures as complications of Cushing’s syndrome, and joint pain as a symptom of adrenal insufficiency. A 2024 review says steroid medicines, with long-term or high-dose use, can increase the risk of a hip bone problem called femoral head necrosis (EFORT Open Reviews, 2024). If you take a steroid medicine for a long time or at a high dose and develop hip or joint pain, tell your prescriber. Don’t stop the medicine yourself.

What about sweating?

None of the symptom lists we use for Cushing’s syndrome or adrenal insufficiency name sweating or sweat odor. We found no source that ties either to cortisol, so we don’t state a link. Sweating has many causes, and a clinician can sort them out if it is new or heavy.

When to see a clinician

• Pain with other signs. Joint or abdominal pain along with long-lasting fatigue, weakness, weight loss or dizziness on standing. NIDDK says to ask a health care professional if you always feel tired, weak or are losing weight.
• Pain with signs of Cushing’s syndrome. Easy bruising, wide purple stretch marks, a round face or high blood pressure. See effects of high cortisol.
• Pain on steroid medicine. Tell the prescriber, and don’t stop or change the dose yourself. See prednisone and cortisol.
• Severe symptoms. Vomiting you can’t stop, fainting or severe weakness need urgent care, not a test.

A cortisol test can’t explain pain on its own. MedlinePlus says a cortisol test alone can’t diagnose the cause of an abnormal level.

Keep reading

• Low cortisol symptoms

  What each symptom can mean, and what doesn't point to cortisol.

• Effects of high cortisol

  What long-term high cortisol can do and how it is worked up.

• Cortisol and inflammation

  What cortisol does to inflammation, and what it doesn't.

• Prednisone and cortisol

  How steroid medicines affect cortisol and its tests.