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Among school children, the anteflexion or school headache described by Gutmann in 1967 is a rather common finding if this type of headache is included in the differential diagnosis. It represents a special type of cervicocranial pain, occurring with prolonged anteflexion of the head while working at a school desk. This condition is caused by hypermobility in the craniovertebral joints with overstretching of the transverse ligament of the atlas, as demonstrated by targeted functional radiography. The affected school children are experiencing headache with increasing intensity as their school day progresses which leads to inattentiveness. Typically the pain can be triggered by forced anteflexion of the head. Physical findings include tenderness of the arch and transverse process of the atlas as well as the dens of the axis. On a reflex level, the manual therapist finds blockages at the atlanto-occipital joint. Treatment aims at eliminating these functional problems and strengthening the postural muscles with physiotherapy. Most importantly, however, prolonged anteflexion of the head should be prevented by using an oblique desk-up device when writing, reading, drawing at school and at home, and to avoid forward rolls during physical education. An oblique desk-up device can be either purchased or easily built at home. In my experience, headache syndromes can be challenging to diagnose. Therefore, functional therapy should only be started after an extensive interdisciplinary morphological workup.

However, should postural school headache be eventually diagnosed, the treatment outlined above is very effective.

DOI: 10.3238/arztebl.2014.0328a

Dr. med. Jürgen Fege

Weißenborn/OT Berthelsdorf, Germany

juergen.fege@gmx.de

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Lewit K, SachseJ, Janda V: Manuelle Medizin. Leipzig: Johann Ambrosius Barth 1983: 417–9.
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Laser T: Muskelverspannung und Rückenschmerz. Stuttgart: Georg Thieme 1996.
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Taubert K: Der Schmerzpatient in der Praxis. Balingen. Spitta Verlag GmbH 1997; 1.
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Straube A, Heinen F, Ebinger F, von Kries R: Headache in school children: prevalence and risk factors. Dtsch Arztebl Int 2013; 110: 811–8. VOLLTEXT
1.Lewit K, SachseJ, Janda V: Manuelle Medizin. Leipzig: Johann Ambrosius Barth 1983: 417–9.
2.Laser T: Muskelverspannung und Rückenschmerz. Stuttgart: Georg Thieme 1996.
3.Taubert K: Der Schmerzpatient in der Praxis. Balingen. Spitta Verlag GmbH 1997; 1.
4.Straube A, Heinen F, Ebinger F, von Kries R: Headache in school children: prevalence and risk factors. Dtsch Arztebl Int 2013; 110: 811–8. VOLLTEXT

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