Tension Headaches and Posture

Suffering from headaches is serious business. The American Headache Society reports that nearly 40% of the population will suffer episodic tension-type headaches every year and roughly 3% of the population suffers from chronic tension headaches. Tension headaches are fairly common, outweighing migraines nearly 5:1. Knowing the difference between a migraine and tension-type headache is important. A proper diagnosis can not only put you on the path to decreasing the frequency of your symptoms, but may lead to resolution altogether.

Tension-type Headache vs. Migraine

Typically a tension headache is characterized by steady ache or tightness that is located at the base of the skull and often radiates into the scalp or forehead (usually both sides). On the other hand, migraines are typically more intense and are thought to be associated with a possible neurologic chemical imbalance. Migraine sufferers typically experience nausea, sensitivity to light or sound, and may often experience a visual aura prior to symptom onset. Unlike tension headaches, migraines often present to a single side of the head.

Being that tension-type headaches outweigh migraine sufferers nearly 5:1, the focus of this article will be on tension headaches, their cause, and how we can affect them through exercise and postural awareness.

The War on Posture

A push for better posture has been a war on all fronts. Poor posture has been linked not only to headaches, but to conditions of the neck, low back, and shoulder. As a society who sits more than ever, the urge for improved posture has been reinforced at most patient touch points.

Poor sitting posture increases the curve of your mid back, essentially requiring hyperextension of your upper neck to keep you looking straight ahead. Slumped sitting activates deep muscles of your neck and creates taut, tender bands of tissue known as trigger points. Prolonged slumped sitting turns your ten pound head into a 30 pound rock. As we slump, small, deep muscles of the upper neck struggle to keep your vision horizontal.

The Suboccipital Triangle

The prolonged contractions of upper neck muscles, known as your suboccipital triangle, creates tenderness, trigger points, and are often the face behind a tension-type headache. The suboccipital triangle muscles contract to extend the upper neck and are often tender. In fact, palpation can often reproduce symptoms.

The research is overwhelming and nearly unanimous. One research study concluded that individuals suffering from headaches were found to have a significantly increased forward head posture paired with decreased neck flexor strength and endurance.1 Looking to the neck as a cause of headaches is nothing new, either. Unfortunately, evaluating the neck is often overlooked by clinicians. A study in 1992 discovered a high occurrence of trigger points in the upper neck, loss of cervical curve, and evidence of upper and lower neck joint dysfunction in subjects suffering from headaches.2

Spinning Your Wheels

It’s simple, really. Self-medicating and performing exercises to manage symptoms is patchwork. Committing to both exercise and posture improvement is the only long term solution. A 2006 study found the degree of forward head posture correlated positively with headache duration, headache frequency, and the presence of upper neck trigger points.3 Your exercises need to combat sitting and the pull of gravity. Tight muscles need to be stretched, while weak ones need strength.

Postural Awareness

Postural awareness is key. Find a trigger that will remind you of posture. A trigger can be a ringing phone or simple email sound notification. Tie the trigger to checking your posture. Hear the phone ring? Ask, “how’s my posture?” With practice you’ll become more aware and stronger. You’ll be able to hold a better posture longer, essentially minimizing the stress to your neck and indirectly decreasing your chance for headaches.

1. Watson D, Trott P. Cervical Headache: An Investigation of Natural Head Posture and Upper Cervical Flexor Muscle Performance. Cephalalgia August 1993 vol. 13 no. 4272-284.
2. Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study. Journal of Manipulative and Physiological Therapeutics [1992, 15(7):418-429]
3. C Fernández-de-las-Peñas1, ML Cuadrado2, JA Pareja. Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia. Volume 26, Issue 9, pages 1061–1070, September 2006.