Resolving a Chronic Headache with Posture Feedback and Breathing


Erik Peper, PhD

This article describes the process by which a 32-year-old woman student’s chronic headaches  that she had since age eighteen were resolved in a single coaching session. The student suffered two or three headaches a week, which initially began when she was eighteen after using digital devices that encouraged her to slouch as she looked down. 

Although she describes herself as healthy, she reported having high level of anxiety and occasional depression. She self-medicated with 2 to 10 Excedrin tablets a week. It is possible that the chronic headaches could partially be triggered by caffeine withdrawal, which get resolved by taking more Excedrin,1 since Excedrin contains 65 mg of caffeine as well as 250 mg of acetaminophen, which can be harmful to liver function.2 


The Behavioral Coaching Intervention

During the first day in class, the student approached the instructor and she shared that she had a severe headache.  During their conversation, the instructor noticed that she was breathing in her chest without abdominal movement, her shoulders were held tight, her posture slightly slouched, and her hands were cold. As she was unaware of her body responses, the instructor offered to guide her through some practices that may be useful to reduce her headache.

The same strategies could also be useful for the other students in the class since headaches, anxiety, zoom fatigue, neck and shoulder tension, abdominal discomfort, and vision problems are common and have increased as people spent more time in front of screens.2-6 These symptoms may occur because of bad posture, neck and shoulder tension, shallow chest breathing, stress, and social isolation.7,8  

When people become aware of their dysfunctional somatic patterns and change their posture, breathing pattern, internal language, and implement stress management techniques, they often report a reduction in symptoms such as irritable bowel syndrome, acid reflux, neck and shoulder tension, or anxiety.9,10 Sometimes, a single coaching session can be sufficient to improve health.

Working hypothesis: The headaches were most likely tension headaches and not migraines and may be the result of chronic neck and shoulder tension, which was maintained during chest breathing and the slouched, head-forward body posture.  If she could change her posture, relax her neck and shoulders, and breathe diaphragmatically so that the lower abdomen widened during inhalation, most likely her shoulder and neck tension would decrease.  Therefore, by changing posture from a slouched to upright position combined with slower diaphragmatic breathing, the muscle tension would be reduced, and the headaches would decrease.


Breathing and Posture Changes

She was encouraged to sit upright so that the abdomen had space to expand.11  In addition, she needed to loosen the clothing around her waist to provide room for her abdomen to expand during inhalation instead of her chest lifting.12 Allowing abdominal expansion can be challenging  for many participants since they are self-conscious about their body image, as well as holding their stomach in—as an unconscious learned response to avoid pain after having had abdominal surgery or as an automatic protective response to threat.13  The upright position also allowed her to sit tall and erect in which the back of the head reaches upward towards the ceiling while relaxing and feeling gravity pulling her shoulders downward and at the same time relaxing her hips and legs.

With guided verbal and tactile coaching, she learned to master slower diaphragmatic breathing in which she gently and slowly exhaled by making a sound of pssssssst (exhaling through pursed lips), which tends to activate the transverse and oblique abdominal muscles and slightly tighten the pelvic floor muscles so that her lower abdomen would slightly constrict at the end of the exhalation.14 Then, by allowing the lower abdomen and pelvic floor to relax so that the abdomen could expand in 360 degrees, inhalation occurred.

While practicing the slower breathing in this relaxed upright position, she was instructed to sense/imagine feeling a flow down and through her arms and out her hands as she exhaled (as if the air could flow through straws down her arms). After a few minutes, she felt her headache decrease and noticed that her hands had warmed.  After this short coaching intervention, she went back to her seat in class  and continued to practice the relaxed effortless breathing while sitting upright and allowing her shoulders to melt downward.


The Use of Muscle Feedback to Demonstrate Residual Covert Muscle Tension

During class session, she volunteered to have her trapezius muscle monitored with electromyography (EMG).  The EMG indicated that her muscles were slightly tense even though she reported feeling relaxed.  With a few minutes of EMG biofeedback exploration, she discovered that she could relax her shoulder muscles by feeling them being heavy and melting.


Implementing Home Practice with a Posture App

As part of the class homework, she was assigned a self-study for two weeks with the posture feedback app, Dario Desktop.  The app uses the computer/laptop camera to monitor posture and provides visual feedback in a small window on the computer screen and/or an auditory signal each time she slouches as shown in Figure 1.

To observe the effect of the posture breathing training, she monitored her symptoms for three days without feedback and then installed the posture feedback application on her laptop to provide feedback whenever she slouched. The posture feedback reminded her to practice better posture during the day while working on her computer and also to do a few stretches or shift to standing when using the computer for an extended period of time. Each time the feedback signal indicated she slouched, she would sit up and change her posture, breathe lower and slower, and relax her shoulders.

She also monitored what factors triggered the slouching. In additionally, she added daily reminders to her phone to remind her of her posture and to stretch and stand after each hour of studying.  After two weeks she recorded her symptoms for three days for the post assessment without posture feedback.


Results

The chronic headache condition that had been present for fourteen years disappeared and she has not used any medication since the first day of class. She reported after two weeks that her shoulder and back discomfort/pain, depression, anxiety, and lack of motivation decreased as shown in Figure 2.  At the fourteen-week follow up, she continues to have no headaches and has not used any medication.  

She used the desktop posture app every time she opened her laptop at home as often as 3-5 times per day (roughly 2-6 hours). In addition, when she felt the beginning of discomfort or thought she should take medication, she would adjust her posture and breathe. While using the app, she identified numerous factors that were associated with slouching as shown in Figure 3.


Discussion

The decrease in depression, anxiety, and increase in motivation may be the direct result of posture change; a slouched position tends to  increase hopeless, helpless, and powerless thoughts while  the upright position tends to increase subjective, felt energy and easier access to empowering and positive thoughts.15-18  

Most likely, a major factor that contributed to the elimination of her headaches was that she implemented changes in her behavior. One major factor was using a posture feedback tool at home to remind her to sit tall and relax her shoulders while practicing slower diaphragmatic breathing. As she noted, “Although it was distracting to be reminded all the time about my posture, it did decrease my neck pain. With the pain reduction, I was able to sit at the computer longer and felt more motivated.”

The combination of slower lower abdominal breathing with the upright posture reversed her protective/defensive body position (tightening the muscle in the lower abdomen and pelvic floor and pressing the knees together while curling the shoulder forward for protection).  The upright posture creates a position of empowerment and trust by which the lower abdomen could expand, which supported health and regeneration.  In addition, the upright posture allowed easier access to positive thoughts and reduced recall of hopeless, powerless, defeated memories.  It is also possible that caffeine withdrawal was a co-factor in evoking headaches.19 By eliminating the medication containing caffeine, she also eliminated the triggering of the caffeine withdrawal headaches.

This case example suggests that health care providers first rule out any pathology and then teach behavioral self-healing strategies that the clients can implement instead of immediately prescribing medications. These interventions could include slower and lower diaphragmatic breathing, upright posture feedback, muscle biofeedback training, heart rate variability training, stress management, cognitive behavior therapy and facilitating health-promoting lifestyle modifications such as regular sleep, exercise, and healthier diet. When students implement these behavioral changes as part of a five-week self-healing program, many report significant decreases in symptoms such as headaches, anxiety, neck and shoulder pain, and gastrointestinal distress.10

More information about these techniques is available here.

Published April 22, 2023


References

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Published April 22, 2023

This January 4, 2022, blogpost was adapted from Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194  


About the Author

Erik Peper, PhD, is an international authority on biofeedback and self-regulation. Since 1970 he has been researching factors that promote healing. Peper is Professor of Holistic Health Studies/Department of Health Education at San Francisco State University. He is President of the Biofeedback Foundation of Europe and past President of the Association for Applied Psychophysiology and Biofeedback. He holds Senior Fellow (Biofeedback) certification from the Biofeedback Certification Institute of America. He has a biofeedback practice at Biofeedback Health (www.biofeedbackhealth.org) and posts articles at https://peperperspective.com.