The neck's flexibility makes it susceptible to wear and tear and to injuries that overstretch it, such as whiplash. Also, the neck has the critical job of holding up the head. Poor posture makes that job more difficult. Thus, neck pain, like back pain (Low Back and Neck Pain: Low Back Pain), is common and becomes more common as people age. For pain located in the front of the neck, see Symptoms of Nose and Throat Disorders: Sore Throat.

The part of the spine in the neck (cervical spine) consists of seven back bones (vertebrae), which are separated by disks made of jelly-like material and cartilage. The spine contains the spinal cord (see Biology of the Nervous System: Spinal Cord and Spinal Cord Disorders: Overview of Spinal Cord Disorders). Along the length of the spinal cord, spinal nerves emerge through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is the spinal nerve root. Muscles and ligaments in the neck support the spine.

Neck pain can involve damage to bones, muscles, disks, or ligaments, but pain can also be caused by damage to nerves or the spinal cord. A spinal nerve root can be compressed when the spine is injured, resulting in pain and sometimes weakness, numbness, and tingling in an arm. Compression of the spinal cord can cause numbness and weakness of both arms and both legs and sometimes loss of bladder and bowel control (incontinence).

Causes

Most of the disorders that can cause low back pain can also cause neck pain, and most involve the spine, the tissues that support it, or both.

Common causes: The most common cause of neck pain is

• Muscle strains and ligament sprains

In such cases, neck pain usually resolves completely.

Other common causes include

• Muscle spasms
• Arthritis (usually osteoarthritis)
• Cervical spondylosis
• A ruptured or herniated disk
• Fibromyalgia

Spasms of the neck muscles are common and may occur on their own or after an injury, even a minor injury.

In cervical spondylosis (see also Spinal Cord Disorders: Cervical Spondylosis), the vertebrae in the neck and the disks between them degenerate, usually because of osteoarthritis. As a result, the nerves that emerge through the vertebrae may be pinched. Sometimes the spinal canal is narrowed (cervical spinal stenosis), and the spinal cord is compressed.

The disks between each of the vertebrae have a tough covering and a soft, jelly-like interior. If a disk is suddenly squeezed by the vertebrae above and below it, the covering may tear (rupture), causing pain. The interior of the disk can bulge out through the tear (herniate). The bulging disk can push on or even damage the spinal nerve root next to it. Rarely, the disk compresses the spinal cord.

Fibromyalgia (see Muscle, Bursa, and Tendon Disorders: Fibromyalgia) is a common cause of pain, sometimes including neck pain. This disorder causes chronic widespread pain in muscles and other soft tissues in areas besides the neck.

Less common causes: Less common causes that are serious include

• A tear in the lining of a neck artery (dissection)
• Meningitis
• A spinal tumor or infection
• A heart attack or angina (chest pain due to an inadequate blood supply to the heart muscle )

Spasmodic torticollis (see also Movement Disorders: Focal and Segmental Dystonias) is also a less common cause but is not as serious as some causes. It is a severe type of spasm that causes the head to tilt and rotate into an abnormal position. Sometimes the spasms are rhythmic, causing the head to jerk. The cause may be unknown or may be due to certain drugs or hereditary disorders.

Evaluation

The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In the evaluation, doctors first try to identify serious disorders.

Warning signs: In people with neck pain, certain signs are cause for concern. They include

• Loss of strength or sensation—possibly a symptom of nerve damage
• Fever
• Night sweats
• Headache
• Lethargy or confusion
• Chest discomfort
• Sudden sweating or difficulty breathing
• Pain that is triggered by exertion or worsens during exertion

When to see a doctor: People with warning signs or difficulty or pain when swallowing should see a doctor immediately. If people without warning signs have severe pain (particularly if it is not relieved by acetaminophen or a nonsteroidal anti-inflammatory drug [NSAID]), they should see a doctor within a day or so. Other people can wait a few days or call their doctor to discuss how soon they need to be seen.

What the doctor does: Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and examination often suggests a cause and the tests that need to be done (see Table 2: Low Back and Neck Pain: Some Causes and Features of Neck Pain).

The physical examination focuses on the spine and nervous system (neurologic examination—see Symptoms and Diagnosis of Brain, Spinal Cord, and Nerve Disorders: Physical Examination) to look for signs of nerve root or spinal cord compression. Signs of nerve root compression include muscle weakness, abnormal reflexes (tested by tapping the tendons around the elbow, below the knee, and behind the ankle), decreased sensation in parts of the body other than the head, inability to urinate, and incontinence of urine or stool. Doctors may ask the person to move the neck in certain ways.

With information about the pain, the person's medical history, and results of a physical examination, doctors may be able to determine the most likely causes:

• Loss of strength or sensation may indicate damage to the spinal cord or nerves or a tear in the lining of a neck artery.
• Pain on the front or one side of the neck usually is not caused by a problem with the spinal cord.
• Pain that radiates down an arm is usually caused by cervical spondylosis with compression of the spinal nerve root.
• Pain that is constant, severe, progressively worse, and unrelieved by rest, particularly if it keeps the person awake at night and is accompanied by sweating, may indicate cancer or an infection.

PrintOpen table in new window
Some Causes and Features of Neck Pain Cause Common Features* Tests More common but less serious causes Sprains and strains Pain that Usually occurs off to one side of the spine Worsens with movement and lessens with rest A doctor's examination Muscle spasms Constant pain and stiffness, causing difficulty or pain when the head is turned one way or the other (sometimes both ways) No symptoms of nervous system malfunction (neurologic symptoms) A doctor's examination Osteoarthritis (without compression of the spinal nerve root ) Pain that Is sometimes constant Worsens with motion Often arthritis in the joints of fingers, hips, and/or knees A doctor's examination Sometimes neck x-rays Cervical spondylosis (with compression of the spinal nerve root) Pain that Often extends down the arm, sometimes to the hand Usually occurs in the neck itself Sometimes weakness and/or numbness in the arms MRI of the neck A herniated disk (typically with compression of the spinal nerve root) Same as for cervical spondylosis MRI of the neck Fibromyalgia Aching and stiffness in many areas of the body (not just the neck) Sore areas that are tender to the touch Often poor sleep Most common among women aged 20 to 50 A doctor's examination Less common but more serious causes A tear in the lining of a neck artery Usually constant head, neck, or facial pain Usually neurologic symptoms such as loss of balance or taste, confusion, weakness of an arm and leg on the same side of the body, and difficulty swallowing, speaking, and/or seeing MRA A bone tumor in the spine Progressively worsening, constant pain (even at night), regardless of position or movement Sometimes night sweats or weight loss MRI Sometimes biopsy Infection of bone or nearby tissues Progressively worsening, constant pain (even at night) regardless of position or movement Sometimes night sweats, fever, and/or weight loss MRI Usually culture of a sample of infected tissue Meningitis Severe headache Neck pain that worsens when the head is bent forward, but not when rotated side-to-side Usually fever, lethargy, and/or confusion A spinal tap (lumbar puncture) and analysis of spinal fluid A heart attack or angina Sudden and sometimes recurring sweating, difficulty breathing, and/or chest discomfort Usually risk factors for heart disease Electrocardiography, blood tests to measure substances called cardiac markers to check for heart damage, and/or imaging tests such as cardiac catheterization or stress testing *Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. MRA = magnetic resonance angiography; MRI = magnetic resonance imaging. Some Causes and Features of Neck Pain Cause Common Features* Tests More common but less serious causes Sprains and strains Pain that Usually occurs off to one side of the spine Worsens with movement and lessens with rest A doctor's examination Muscle spasms Constant pain and stiffness, causing difficulty or pain when the head is turned one way or the other (sometimes both ways) No symptoms of nervous system malfunction (neurologic symptoms) A doctor's examination Osteoarthritis (without compression of the spinal nerve root ) Pain that Is sometimes constant Worsens with motion Often arthritis in the joints of fingers, hips, and/or knees A doctor's examination Sometimes neck x-rays Cervical spondylosis (with compression of the spinal nerve root) Pain that Often extends down the arm, sometimes to the hand Usually occurs in the neck itself Sometimes weakness and/or numbness in the arms MRI of the neck A herniated disk (typically with compression of the spinal nerve root) Same as for cervical spondylosis MRI of the neck Fibromyalgia Aching and stiffness in many areas of the body (not just the neck) Sore areas that are tender to the touch Often poor sleep Most common among women aged 20 to 50 A doctor's examination Less common but more serious causes A tear in the lining of a neck artery Usually constant head, neck, or facial pain Usually neurologic symptoms such as loss of balance or taste, confusion, weakness of an arm and leg on the same side of the body, and difficulty swallowing, speaking, and/or seeing MRA A bone tumor in the spine Progressively worsening, constant pain (even at night), regardless of position or movement Sometimes night sweats or weight loss MRI Sometimes biopsy Infection of bone or nearby tissues Progressively worsening, constant pain (even at night) regardless of position or movement Sometimes night sweats, fever, and/or weight loss MRI Usually culture of a sample of infected tissue Meningitis Severe headache Neck pain that worsens when the head is bent forward, but not when rotated side-to-side Usually fever, lethargy, and/or confusion A spinal tap (lumbar puncture) and analysis of spinal fluid A heart attack or angina Sudden and sometimes recurring sweating, difficulty breathing, and/or chest discomfort Usually risk factors for heart disease Electrocardiography, blood tests to measure substances called cardiac markers to check for heart damage, and/or imaging tests such as cardiac catheterization or stress testing *Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. MRA = magnetic resonance angiography; MRI = magnetic resonance imaging.

Testing: Often, testing is not necessary because most neck pain is caused by sprains and strains, which doctors can typically diagnose based on the examination. Testing is usually done if doctors suspect certain other disorders (see Table 2: Low Back and Neck Pain: Some Causes and Features of Neck Pain). If people have symptoms of nervous system malfunction (neurologic symptoms), such as weakness or numbness, magnetic resonance imaging (MRI) or computed tomography (CT) is usually done. MRI provides clearer images of soft tissues (including disks and nerves) than CT. MRI and CT provide better images of bones than plain x-rays. However, plain x-rays can often identify common abnormalities in bone (such as arthritis), so if doctors suspect such an abnormality, x-rays may be done first.

Occasionally, electromyography and nerve conduction studies (see Symptoms and Diagnosis of Brain, Spinal Cord, and Nerve Disorders: Electromyography and Nerve Conduction Studies) are done to evaluate possible nerve root compression.

Treatment

Specific disorders are treated. For example, if the spinal cord or a spinal nerve is compressed, surgery is usually needed.

Most often, a sprain, strain, or other musculoskeletal injury is the cause and an over-the-counter analgesic, such as acetaminophen or an NSAID, to relieve the pain is all that is needed. Symptoms usually resolve completely. If inflammation is not contributing to the pain (as with sprains, strains, and other injuries), acetaminophen is usually recommended because it is thought to be safer than NSAIDs. Ice or heat may also help (see Rehabilitation: Treatment of Pain and Inflammation). People are taught how to stand, sit, and sleep in ways that do not strain the neck.

Avoiding aggravating activities, such as sitting for extended periods of time (particularly when also using a computer, phone, or other electronic device), may help. People should use good posture and body mechanics when standing, sitting, lying down, or doing any activity. People who sleep on their side should use a pillow to support the head and neck in a neutral position (not tilted down toward the bed or up toward the ceiling). People who sleep on their back should use a pillow to support, but not raise, the head and neck. People should avoid sleeping on their stomach. Doctors or physical therapists may suggest stretching and strengthening exercises, including strengthening exercises for the upper back.

If more pain relief is needed, doctors may prescribe opioid analgesics. Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes used, but their usefulness is controversial. Muscle relaxants are not recommended for older people, who are more likely to have side effects.

For spasmodic torticollis, physical therapy or massage can sometimes temporarily stop the spasms. Drugs (including the anticonvulsant carbamazepine and some mild sedatives such as clonazepam, taken by mouth or injected) can usually relieve the pain. But drugs control spasms in only up to one third of people. If the pain is severe or if posture is distorted, botulinum toxin (a bacterial toxin used to paralyze muscles) may be injected into the affected muscles.

Key Points

• Most neck pain is caused by sprains and strains and resolves completely.
• Most of the disorders that can cause low back pain can cause neck pain.
• People with warning signs, such as nerve damage, should see a doctor immediately.
• Most neck pain can be relieved by over-the-counter analgesics and modification of activities.

Last full review/revision March 2013 by Alfred J. Cianflocco, MD, FAAFP