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Definition

Neck pain is discomfort in any of the structures in the neck. These include the muscles, nerves, bones (vertebrae), joints, and the discs between the bones.

Alternative Names

Pain - neck; Neck stiffness; Cervicalgia; Whiplash; Stiff neck

Considerations

When your neck is sore, you may have difficulty moving it, such as turning to one side. Many people describe this as having a stiff neck.

If neck pain involves compression of your nerves, you may feel numbness, tingling, or weakness in your arm or hand.

Causes

A common cause of neck pain is muscle strain or tension. Most often, everyday activities are to blame. Such activities include:

• Bending over a desk for a long time (often an hour or more)
• Having poor posture while watching TV or reading
• Having your computer monitor positioned too high or too low
• Sleeping in an uncomfortable position
• Twisting and turning your neck in a jarring manner while exercising
• Lifting things too quickly or with poor posture

Accidents or falls can cause severe neck injuries, such as vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include:

• Medical conditions, such as fibromyalgia
• Cervical arthritis or spondylosis
• Ruptured disk
• Small fractures to the spine from osteoporosis
• Spinal stenosis (narrowing of the spinal canal)
• Sprains
• Infection of the spine (osteomyelitis, diskitis, abscess)
• Torticollis
• Cancer that involves the spine

Home Care

Treatment and self-care for your neck pain depend on the cause of the pain. You will need to learn:

• How to relieve the pain
• What your activity level should be
• What medicines you can take

For minor, common causes of neck pain:

• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
• Apply heat or ice to the painful area. Use ice for the first 48 to 72 hours, and then use heat after that.
• Apply heat with warm showers, warm compresses, or a heating pad. To prevent injury to your skin, DO NOT fall asleep with a heating pad or ice bag in place.
• Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
• Do slow range-of-motion exercises, up and down, side to side, and from ear to ear. This helps gently stretch the neck muscles.
• Have a partner gently massage the sore or painful areas.
• Try sleeping on a firm mattress with a pillow that supports your neck. You may want to get a special neck pillow.
• Ask your health care provider about using a soft neck collar to relieve discomfort. However, using collar for a long time can weaken neck muscles. Take it off from time to time to allow the muscles to get stronger.

When to Contact a Medical Professional

Seek medical help right away if you have:

• A fever and headache, and your neck is so stiff that you cannot touch your chin to your chest. This may indicate meningitis. Call 911 or the local emergency number or get to a hospital.
• Symptoms of a heart attack, such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain.

Contact your provider if:

• Symptoms do not go away in 1 week with self-care
• You have numbness, tingling, or weakness in your arm or hand
• Your neck pain was caused by a fall, blow, or injury -- if you cannot move your arm or hand, have someone call 911 or the local emergency number
• You have swollen glands or a lump in your neck
• Your pain does not go away with regular doses of over-the-counter pain medicine
• You have difficulty swallowing or breathing along with the neck pain
• The pain gets worse when you lie down or wakes you up at night
• Your pain is so severe that you cannot get comfortable
• You lose control over urination or bowel movements
• You have trouble walking and balancing

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask about your neck pain, including how often it occurs and how much it hurts.

Your provider will probably not order any tests during the first visit. Tests are only done if you have symptoms or a medical history that suggests a tumor, infection, fracture, or serious nerve disorder. In that case, the following tests may be done:

• X-rays of the neck
• CT scan of the neck or head
• Blood tests, such as a complete blood count (CBC)
• MRI of the neck

If the pain is due to muscle spasm or a pinched nerve, your provider may prescribe a muscle relaxant or a more powerful pain reliever. Over-the-counter medicines often work as well as prescription drugs. At times, your provider may give you steroids to reduce swelling. If there is nerve damage, your provider may refer you to a neurologist, neurosurgeon, or orthopedic surgeon for consultation.

References

Hudgins TH, Origenes AK, Pleuhs B, Alleva JT. Cervical sprain or strain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 6.

Kosty J, Nasser R, Vasquez RA, Wong CC, Cheng JS. Neck pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier;2021:chap 48.

Ronthal M. Arm and neck pain. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 32.

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