Neck pain has many potential causes ranging from acute problems, like muscle strains and whiplash, to conditions that develop over time, such as cervical spondylosis (neck osteoarthritis) and myofascial pain syndrome. Pinched nerves, infections, fractures, and spinal cord problems are other possible reasons you may be experiencing neck pain.
Diagnosing your neck pain first entails a detailed medical history, whereby your doctor will ask you questions about the location, intensity, and quality of your pain—like whether your pain is mild versus severe or burning versus sharp. Then, your doctor will perform a physical exam, sometimes followed by testing.
Getting to the bottom of your neck pain is important so you can move forward with an appropriate and effective treatment plan, which will differ depending on the reason for your discomfort.
Your neck consists of multiple bones, ligaments, discs, muscles, and nerves that make up the top part of your spinal cord. Injury or disease to any of these structures may lead to neck pain.
Most cases of neck pain are due to a musculoskeletal problem.1
A strain to the neck muscles, called neck (cervical) strain, occurs when the muscles in the neck are overstretched or torn. This may result from an injury (e.g., a motor vehicle accident) or from everyday stresses like poor posture and sleep habits.
The initial pain of a neck strain is often reported as sharp or knife-like. As time goes on, the pain often becomes more aching or throbbing in quality. Besides pain, other symptoms of a neck strain include stiffness and muscle spasms.
Whiplash is an event that may cause a neck strain (when the muscles are overstretched or torn) or sprain (when the ligaments are overstretched or torn).
Whiplash occurs when an external force causes your neck to suddenly go into hyperextension (an extreme amount of neck and back arching) followed quickly by hyperflexion (an extreme amount of forward bending).
While the most common cause of whiplash is a rear-end car accident, contact sports injuries (e.g., football) and physical abuse (e.g., shaken baby syndrome) may also lead to a whiplash injury.2
Besides neck pain, which may range in intensity from mild to severe, other symptoms of whiplash include:
Neck and shoulder muscle spasm
Reduced neck flexibility range of motion
Inability to move your neck
A headache, especially one at the back of your head
Cervical spondylosis, also referred to as osteoarthritis of the neck, is the name given to degenerative or "wear and tear" changes to the small joints and cartilage in your neck. The pain from cervical spondylosis ranges in intensity from mild to severe, usually improves with rest, and may be associated with headaches or popping sensations (crepitus) when turning your neck.
As the cartilage in your neck continues to wear down, bony growths (bone spurs) may develop. These take up space and may eventually place pressure on nerves that run down the spine. Compressed nerves can then lead to numbness, tingling, and electrical sensations in the arms and shoulders.
Overall, cervical spondylosis is an extremely common condition, especially in middle to older-aged individuals. Besides age, other factors that increase a person's risk for developing cervical spondylosis include:
A job involving repetitive neck motions or heavy lifting
Prior injury or trauma to the neck
A family history of the condition
Depression or anxiety4
Cervical Discogenic Pain
Cervical discogenic pain is brought about by changes in the structure of one or more of the discs in your neck, which serve as cushions between neck bones. This change in disc architecture may result from an injury or more commonly occur as a result of the natural aging process.
Common symptoms of discogenic pain include:
Aching or burning pain in the neck when turning or tilting the head5
Pain or odd sensations that move into the arm or shoulder, caused by fraying of tough outer fibers (called the annulus fibrosus) of a disc
A grinding feeling with neck movement
Weakness in the limbs
Numbness in the shoulders, arms, or hands
Bladder or bowel control problems6
Pain that gets worse when the neck is held in one position for prolonged periods, such as when you drive, read, or work on a computer
Muscle tightness and spasms4
Myofascial pain—that which comes from tight, tender areas of a muscle that are also sensitive to pressured touch—can develop after a neck injury or because of chronically poor posture.7 The pain, often reported as deep and aching, often comes in the form of trigger points, which can be felt as hard nodules in the muscle under your fingers.
When pressed (or even simply touched in some cases,) trigger points are not only locally painful, but they refer to other areas as well, such as the shoulder, upper back, or back of the head.
A fracture of one of the seven bones in the neck (called your cervical vertebrae) often occurs as a result of major trauma, like a car accident, high-impact sports injury, or fall.
Along with severe neck pain that may spread to the shoulders and arms, bruising and swelling may also be present. The most worrisome consequence of a neck fracture is damage to the spinal cord, which can lead to paralysis or death.8
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Diffuse idiopathic skeletal hyperostosis (DISH) occurs when ligaments and tendons that run along your spine calcify and harden. Many people with DISH do not have any symptoms, but those that do often report severe pain and stiffness in the neck and upper back that worsens over time.
In addition to musculoskeletal conditions, nerve problems may cause neck pain.
Keep in mind, in many instances, a combination of nerve and musculoskeletal problems is the source behind a person's neck pain.
Radiculopathy occurs when a spinal structure puts pressure on or otherwise irritates a nerve root, which is a group of nerves that branches off the spinal cord and exits the spine via holes on the sides known as foramina.
Usually, the culprits behind a person developing cervical (neck) radiculopathy are protruding or herniated discs and degenerative changes in the discs from aging or injury.
Symptoms of cervical radiculopathy include an aching or burning pain in the neck, upper arm or shoulder, or between the shoulder blades. Sometimes the pain occurs in the chest, breast, or face. Pins-and-needles sensation, numbness, and weakness may also occur in the arms.
Central Cord Syndrome
Central cord syndrome refers to damage to the spinal cord as a result of an injury to the neck, tumor in the spinal cord, or cervical spondylosis. Central cord syndrome is a serious problem, much more so than cervical radiculopathy, because it affects more than just spinal nerve roots.
Besides neck pain and a reduced range of motion, central cord syndrome of the neck usually causes people to experience numbness and weakness in their hands and arms. In severe cases, a person may experience difficulty walking, controlling their bowel or bladder, and sexual dysfunction.
Besides musculoskeletal and nerve conditions, other causes of neck pain include cervical artery dissection, meningitis, infections localized to tissues within the neck, and cancer.
Meningitis refers to inflammation of the meninges, which are tissues that line your brain and spinal cord.
The most common symptoms of meningitis include:
Nausea or vomiting9
In some cases, seizures11
With a deadly form of bacterial meningitis called meningococcal meningitis (caused by the bacteria, Neisseria meningitides), a dark, purple rash may form.
Cervical Spine Infections
Uncommonly, but very seriously, an infection of the cervical spine—either due to a bacterium, fungus, or tuberculosis—may occur.
Three types of neck infections include:
Vertebral osteomyelitis: An infection involving one or more cervical vertebrae (one of the seven bones in the neck)
Discitis: An infection of one of the discs in the neck
Epidural abscess: A collection of pus within the spinal canal, which is the tunnel that houses the spinal cord
Constant neck pain, including night pain, is the most common symptom of a person with a cervical spine infection. Other symptoms may include:12
Rarely, an infection within the deeper tissue layers of the neck (called a deep space neck infection) may occur. Besides neck pain, other symptoms may be present depending on the location of the infection; examples include a sore throat, trismus (inability to open the jaw), breathing difficulties, and problems or pain with swallowing.
Certain head and neck cancers, such as salivary gland cancer, may cause neck pain.13
In addition, cancer that has spread (metastasized) from another area of the body to the cervical spine may cause pain.
Cervical Artery Dissection
Cervical artery dissection is a tear in the wall of your carotid or vertebral artery caused by breakdown in the layers of the arterial wall. This life-threatening condition is usually caused by trauma, including unnoticed minor trauma. It leads to a stroke or transient ischemic attack in more than 50% of cases.14
Other symptoms include:
Pain in the neck or face, especially around the eyes
Small pupil on the affected side
Drooping eyelid on the affected side
Whooshing sound in one ear
Sudden drop in sense of taste
Weakness on one side of the body
When to See a Doctor
Considering there are many potential causes of neck pain, it's important to seek medical attention. This is especially true if you have experienced any sort of injury or trauma to your neck, pain is severe/worsening/persistent (not improving after one week), or your pain keeps you up at night.
Associated symptoms that also warrant seeking medical attention include:
Tingling, numbness, and/or weakness that moves down your arms or legs
A headache or dizziness
Lost control over your bladder or bowels
Loss of balance
Fever or chills
Diagnosing the cause of neck pain can be a difficult task. Even with the many tests and exams available to doctors today, differentiating between likely causes can be challenging.
To start the diagnostic process, your doctor will first determine whether your neck pain is traumatic or non-traumatic. Neck pain from an acute trauma is usually seen in an emergency room and requires a faster pace of care.
Traumatic Neck Pain Evaluation
If you experience trauma to your neck and are being treated by the paramedics or emergency room providers, you will need to be stabilized first. While an initial part of your treatment, the steps followed also help providers gather information that will be used to form a diagnosis.
Stabilization, Vitals, and Immobilization
In trauma situations, care providers will first administer first aid and immobilize your neck with a backboard and rigid cervical collar with head supports on the sides. Once you're stabilized, the healthcare team will check your vitals, which can provide clues into the seriousness of your condition.
In many instances of acute neck trauma, your emergency care team will then proceed with urgent imaging of your neck, skipping the more intensive, detailed medical history and examination that a person with non-traumatic neck pain would experience.
Non-Traumatic Neck Pain Evaluation
If you have not experienced a recent major neck trauma, your doctor will begin with a medical history and a detailed neck and neurological examination.
During your medical history, your doctor will inquire about the intensity, duration, quality, and location of your neck pain.
He will also ask inquire about "red flag" symptoms that could indicate a serious or potentially life-threatening diagnosis (e.g., spinal cord compression, cancer, infection, etc.). Like neck trauma, the presence of "red flag" symptoms often warrants moving forward with urgent neck imaging.
Once it's time for your physical examination, your practitioner will begin looking for signs of bruising, swelling, masses, or lumps. He will also access your neck range of motion and press on your neck muscles to check for tenderness, spasm, and trigger points.
A neurological examination will be performed in most cases of neck pain. Besides accessing muscle strength, skin sensation, and reflexes, your doctor may perform pertinent maneuvers or tests.
One such test, called the Spurling test or maneuver, is particularly useful for reproducing signs of cervical radiculopathy.16 In this test, your doctor presses on the top of a patient's head and turns it toward the side of the neck pain. The test is positive if this maneuver reproduces the pain or other sensory disturbances like tingling.
Another maneuver your doctor may perform is called the Lhermitte's sign, in which a person experiences a shock-like sensation where their neck is flexed.17 If positive, this test suggests a possible cervical cord compression, which may occur as a result of a herniated disc, bone spur, tumor, or multiple sclerosis lesion.
Besides acute neck trauma, imaging is generally reserved for a person with physical exam deficits associated with their neck pain. It's also indicated for people experiencing "red flag" symptoms or any new, persistent, or worsening neck pain and/or neurological symptoms.
For example, a magnetic imaging resonance (MRI) of the cervical spine may be ordered to evaluate for cervical radiculopathy. An MRI of the cervical spine is also ordered if an infection or malignancy is suspected.
Moreover, a cervical spine X-ray and/or computed tomography (CT) scan may also be ordered to confirm a suspected neck fracture or diagnose cervical spondylosis.
Blood tests, most notably a white blood cell count and blood cultures, may be ordered if your doctor is worried your neck pain may be due to meningitis or cervical spine infection.
While it's logical to think that neck pain must arise from the neck, this is not always the case. In fact, several medical conditions can either refer pain to the neck or cause neck pain, amongst other more prominent symptoms. For example, a gallbladder attack, rotator cuff tear, tension-type headache, migraine, or more seriously, a heart attack may be associated with neck pain.
In these instances, there are usually other symptoms or diagnostic clues present. For example, with a migraine, an aura may be reported along with throbbing, one-sided head pain, nausea and/or vomiting, and a sensitivity to light. Likewise, if your doctor suspects a gallbladder attack, an ultrasound and liver blood tests will be ordered to look for evidence of one. If angina or a heart attack is suspected, an electrocardiogram (ECG) and cardiac enzymes (a blood test) will be ordered.
Sometimes, whole-body rheumatological conditions—such as fibromyalgia, rheumatoid arthritis, and polymyalgia rheumatica—are behind a person's neck pain. In these cases, though, there are usually other areas of pain besides the neck. Certain blood tests, such as the inflammatory marker erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), can also help sort out the diagnosis.
Treating your neck pain depends entirely on your underlying diagnosis but often includes a combination of therapies like medications and physical therapy.
Ice and Heat Therapy
For neck strains, applying a cold pack to the affected area for 15 to 30 minutes at a time, four times a day for the first two to three days after the injury can reduce inflammation and soothe pain. This can then be followed by applying moist heat—a warm bath or shower—to your neck to loosen tight muscles.
For a musculoskeletal or nerve-related neck pain diagnoses, various medications may be recommended by your doctor including muscle relaxants, nonsteroidal anti-inflammatories (NSAIDs), Tylenol (acetaminophen), or opioids if your pain is severe.
Oral steroids (e.g., prednisone) or a steroid injection (cortisone) may be recommended for the diagnosis of cervical radiculopathy or central cord syndrome. Steroids not only work to alleviate pain, but they help reduce inflammation.
For a diagnosis of meningitis or a neck infection, antibiotics and/or anti-viral or anti-fungal medications will be given through your vein (called intravenous administration).
If not contraindicated, antiplatelet medications (e.g., aspirin) or anticoagulant drugs—heparin followed by Coumadin (warfarin)—are used to treat a cervical artery dissection followed by surgery.
For neck strains and cervical radiculopathy, your physical therapist may perform specific exercises to ease neck pain, strengthen your neck muscles (with cervical traction), and improve your neck range of motion. For cervical spondylosis, in addition to stretching your muscles, posture therapy and wearing a soft cervical collar may be recommended for short periods of time.
Sometimes complementary therapies are used in conjunction with traditional medications or therapies to alleviate discomfort. For instance, massage therapy, acupuncture, or biofeedback may be helpful for neck strains. Trigger point injections may be used to treat myofascial pain.
Surgery is not commonly used to treat neck pain, but it may be warranted in certain situations.
For example, with persistent or severe cases of cervical radiculopathy, there are three surgeries that are usually performed, according to the American Academy of Orthopedic Surgeons:18
Anterior cervical discectomy and fusion (ACDF): Removal of the herniated or degenerating disc that is pinching the nerve followed by fusion of the vertebrae
Artificial disc replacement (ADR): Removal of the degenerated disc so that it can be replaced with an artificial one
Posterior cervical laminoforaminotomy: Removal of the bone, bone spur, and surrounding tissues that are pinching the affected nerve
In addition, surgery—an angioplasty with or without stent placement—is needed to repair a dissected cervical artery. This type of surgery is usually performed by an interventional cardiologist or vascular surgeon.
While it's not possible to prevent every neck pain diagnosis, especially those related to age (e.g., cervical spondylosis), there are some things you can do to help manage your pain and minimize your chances of sustaining a neck trauma or injury
Maintain proper posture: For example, if you look at a computer for long periods of time, minimize tension in your neck by sitting eye-level with your computer screen and taking periodic breaks to stand up and stretch.
Alleviate stress: Consider relaxation techniques or mindfulness meditation.
Talk with your doctor about the best sleeping position for you: For example, he may recommend avoiding sleeping on your stomach or recommend using a neck roll, rather than a pillow.
Buckle up: Always be sure to wear your seat belt and do so properly.
Protect yourself during activities: Wear protective equipment (e.g., helmet, harness, etc.), use a spotter, and use cushioned mats (if possible) when engaging in sports or other physical activities that may pose harm to your head or neck.
Be safe when swimming: Avoid diving into a shallow pool or body of water
Keep your home safe: Look for opportunities to minimize your need to reach for things and make changes to minimize falls.
A Word From Verywell
It's easy to write off pain in the neck as, well, a proverbial pain in the neck, especially when it's just mild and nagging. But remember that pain is your body's way of telling you something is wrong—either with your daily movement or with your body itself. Be sure to have any neck pain evaluated by your doctor so you can not only obtain the relief you need but you can get ahead of any potential future damage.