How Posture Affects Your Headaches

How many of us grew up being fussed at by parents and grandparents to “sit up straight” or “stop slouching”? Well it turns out, they were onto something. Farmer et al published a study in 2015 concluding that while poor postural habits may not trigger headaches in asymptomatic individuals, posture certainly participates in perpetuating the headache. Those who suffer from migraine, cervicogenic and tension type headaches, are all more likely to have a forward head rounded shoulder posture. Let’s be honest, any of us who sit a lot, use computers, smartphones, and tablets all struggle with a forward head  rounded shoulder posture, whether we suffer from regular headaches or not.


What is Forward Head Rounded Shoulder Posture?

The “Forward Head” part of this is when the head is held in front of the shoulders. Ideally, the ear is in line with the shoulders. This reduces strain to the neck. When our head is past our shoulders, it causes the muscles in the back of the neck to work harder and harder. It is estimated that for every inch our head is past our shoulders, it’s like adding an extra 10 lbs to the weight of our head.  For example, if your 11 lb head is 4 inches past your shoulders, your muscles now need to provide enough counterforce for a 51 lb head (40 lbs +11 lbs)!


The “Rounded Shoulders” part describes when the shoulders are rounding inwards and move in front of your hips. See the picture above and how the shoulders are rolled inwards to the chest? When this type of posture is used over and over and over again, the chest muscles become tight while the muscles around the shoulder blades become stretched out and weak.


So What Is Good Posture?

“Good” posture is when the ear is in line with the shoulder, which is in line with the hip. For most people, this is easier to accomplish in standing. This is because in standing, our low back naturally tends to curve that allows our spine to line up perfectly. Sitting is a different story. When we sit, the natural curve of our low back tends to flatten out. This allows the upper back and neck to go into the forward head rounded shoulder posture more easily. We tend to use our computers, smartphones, tablets, and other screens while sitting, which  further exacerbates the position of our head and shoulders.


What to do?

The first step in solving any problem is to be aware of the problem. Poor postural habits are the norm for most people, which mean that slouching feels “normal” and sitting with good posture feels awkward. I have patients set a timer or an alarm to “check in” with their posture every hour. At first, sitting with good posture is going to be hard and tiring – you may even feel sore from using muscles that haven’t been used in awhile! The next step I have patients take is to send me pictures so we can make adjustments to their desk setup. Sometimes this means raising or lowering their screen, getting a new chair, adjusting armrests, getting keyboard trays or lumbar supports, and more. Every setup is different and everybody is built differently, but one universal adjustment that works for most is to add a bit more lumbar support so that the low back maintains its natural arch. This will help the spine to automatically move the back over top of the spine instead of sitting in front of the spine.


By becoming aware of your posture and taking steps to make improvements, you can relieve neck tension and headaches!



Dr. Etheredge is a physical therapist who specializes in treating patients with headaches, neck pain and dizziness. Many of her patients have multiple diagnoses and complex needs. Dr. Etheredge is certified and dry needling and has been using this modality for years to assist her patients in achieving their goals. Learn more about Dr. Etheredge here .