Neck pain

  • 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, especially 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 hours
      • 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:

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

      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, hot 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 be meningitis. Call your local emergency number (such as 911) or get to a hospital.
      • Symptoms of a heart attack, such as shortness of breath, sweating, nausea, vomiting, or arm or jaw pain.

      Call 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
      • 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:

      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
    • Barnsley L. Neck pain. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 71.

      Cheng JS, McGirt JW, Devin C. Neck pain. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 45.

      Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015;90(2):284-299. PMID: 25659245

      Najera LV, Alleva JT, Mohr N, Origenes AK, Hudgins TH. Cervical sprain or strain. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 6.