Merck Manual

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Some Causes and Features of Neck Pain

Some Causes and Features of Neck Pain

Cause

Common Features*

Tests

More common but less serious causes

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 in people with 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 arm more than 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, above except neck pain can be as severe or more severe than the arm pain

MRI of the neck

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 (an MRI with injection of dye to allow doctors to see the arteries in the neck)

Angiography

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

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

Sudden and sometimes recurring sweating, difficulty breathing, and/or chest discomfort

Usually risk factors for heart disease

Usually also pain in the chest

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.