Poor Posture and Tension Headaches

Most people with complaints of headaches will have a postural or musculoskeletal component causing the pain. Approximately 80% of people with headaches have difficulty engaging in daily activities.  Research indicates an increase in the incidence of headaches accompanied by sleep disorders, depression, anxiety, and decreased quality of life and inability to concentrate.1,2    

Headache disorders are a common problem seen in physical therapy.  Research indicates varied types of headaches identifying tension-type headache (TTH) as the most frequently seen in adults.3  Three percent of adults seeking treatment have daily headaches while 14% of adults report having a TTH one time per week.1

Forward head posture (FHP) represents the most common postural change in adults with several studies demonstrating an association between TTH and FHP.3  As discussed in our previous blog (READ ABOUT POSTURE AND NECK PAIN HERE), a “normal” posture is one where the ear is positioned directly over the shoulder while a forward head posture brings the head forward, away from the body.  

Research shows that patients with FHP exhibit weakness in the posterior and anterior muscles of the neck.4   Such changes can lead to increased pressure between the cervical spine vertebrae and the development of tender areas within the neck region. These tender areas are also known as trigger points which can refer pain to the base of the skull and are correlated with headache duration and frequency.5

Under the supervision of your PT, stretches and exercises have been shown to be effective treatments for this posture as well as a reduction in pain and headaches. 2,6,7  Manual therapy has also been shown to be beneficial for improving trigger points as well as improving joint mobility in the cervical spine.8  Melanie Massey Physical Therapy has locations in Shreveport, Ruston, West Monroe, and Monroe to help you improve your posture and reduce your symptoms.


1. Falsiroli Maistrello L, Rafanelli M, Turolla A. Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Pain Headache Rep. 2019;23(10):78. doi:10.1007/s11916-019-0815-8

2. Nobari M, Arslan S, Hadian M, Ganji B. Effect of Corrective Exercises on Cervicogenic Headache in Office Workers with Forward Head Posture. J Mod Rehabil. 2017;11(4):201-208.

3. Fernandez-de-las-Peñas C, Pérez-de-Heredia M, Molero-Sánchez A, Miangolarra-Page JC. Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study. J Orthop Sports Phys Ther. 2007;37(2):33-39. doi:10.2519/jospt.2007.2401

4. Kocur P, Wilski M, Goliwąs M, Lewandowski J, Łochyński D. Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone, Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs. J Manipulative Physiol Ther. 2019;42(3):195-202. doi:10.1016/j.jmpt.2019.02.005

5. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache. 2006;46(3):454-460. doi:10.1111/j.1526-4610.2006.00288.x

6. Lee E, Lee S. Impact of Cervical Sensory Feedback for Forward Head Posture on Headache Severity and Physiological Factors in Patients with Tension-type Headache: A Randomized, Single-Blind, Controlled Trial. Med Sci Monit Int Med J Exp Clin Res. 2019;25:9572-9584. doi:10.12659/MSM.918595

7. Lee J-H. Effects of forward head posture on static and dynamic balance control. J Phys Ther Sci. 2016;28(1):274-277. doi:10.1589/jpts.28.274

8. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):86. doi:10.1186/s12891-019-2438-y


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