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Health & Exercise Forum

Preventing headaches in children: Part 2

May 28, 2018

Dr. Mackarey's Health & Exercise ForumPrevention of Headaches Associated with Neck Pain in Children and Adolescents: Part 2 of 2

Last week, Kelley German, MD3, GCSOM guest author wrote about the causes of headaches in children and adolescents. This week, we will discuss two additional causes, more mechanical than medical, but common none-the-less: poor posture and stress.

Neck pain and headaches, are among the most common ailments for children and adolescent students. It is widely accepted in the medical community that keeping fit, (flexible and strong), practicing good posture, and using proper body mechanics and ergonomics and managing stress are essential in the prevention of neck pain and headaches in children and adolescents.


Children and adolescents are notorious for sitting, reading, using their computers, watching television or playing video games with poor posture. Over time, the forward head, rounded shoulders and slumped spine can shorten the muscles and ligaments of the spine and compress nerves and cause headaches. Once other causes of headaches has been ruled out by your physician, a physical therapist can teach posture stretching and strengthening exercises to prevent or alleviate this problem.

Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.

Perform postural exercises throughout the day. Most of the day we sit, stand, and reaching forward and bend our spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day (while sitting at your desk).

  • Chin Tuck: Tuck your chin back to bring your head over shoulders.
  • Shoulder Blade Pinch: Pinch your shoulder blades together.
  • Standing Extension: While standing, put your hands behind back and extend lower back 10-20 degrees.

Sitting: When sitting, use an ergonomic chair at work station with a lumbar support and adjustable height. Get close to your keyboard and monitor. Stand up and perform the above postural exercises every 45-60 minutes. If you are working on a laptop or tablet, use a lap desk or place a pillow or two on your lap to elevate the device.


It is commonly known that stress and tension can cause headaches and children and adolescents often suffer from stress. Tension headaches often present as a dull ache, tightness or pressure across the forehead and tightness in the muscles of the shoulders and neck. Once other causes of headaches has been ruled out by your physician, a physical therapist can teach relaxation techniques along with postural exercises.

  • Physical Activity and Exercise – to improve posture and control stress. Simple physical activity can be helpful in children, however, a more structured program may be more appropriate for adolescents and teens.
  • Weight Training –
    • Performed 2-3 times per week, 20-30 repetitions with light weights through full range of motion
    • Avoid spinal loading from overhead lifting such as military or overhead press
  • Aerobic Exercises –
    • 3-4 times per week for 30-45 minutes at moderate intensity
    • Treadmill, bike, recumbent bike, elliptical, walk, cross-country ski
  • Core Exercises –
    • Core stabilization exercises designed to strengthen the neck, middle, lower back and abdominal muscles will help prevent injury. Core exercises should be performed while standing on a Bosu ball, discs or pillows to create unstable surface. Sitting on an exercise ball is another option. Once you are able to maintain a center of gravity and balance, try using light weights or bands and perform: bicep curls, shrugs, rows and lats.

Talk to Your Physician

If you believe your child is having difficulty with stress and may be the source of headaches and other physical problems, talk to your physician. It may be determined that counseling, along with exercise and relaxation techniques may be appropriate.

Progressive Muscle Relaxation
Progressive Muscle Relaxation is a relaxation technique used to release stress. It can relax the muscles and lower blood pressure, heart rate, and respiration. Progressive Muscle Relaxation is the tensing and then relaxing each muscle group of the body, one group at a time. Though this technique is simple it may take several sessions before it is 'mastered.' Progressive muscle relaxation may be done sitting or lying down.

Some people prefer to listen to an audio that guides one through progressive muscle relaxation.

Visit YouTube: Progressive Muscle Relaxation and select from a variety of videos.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.