Causes, Treatment, and When to See a Healthcare Provider

Causes of neck pain include acute conditions, like muscle strains and whiplash, and chronic conditions, such as cervical spondylosis (neck osteoarthritis) and myofascial pain syndrome. Pinched nerves, infections, fractures, and spinal cord problems can also cause neck pain.

Getting to the bottom of your neck pain is essential to starting an appropriate and effective treatment plan, which will differ depending on the reason for your discomfort.

This article will go over the causes of neck pain, as well as how neck pain is diagnosed and treated.

Illustration by Alexandra Gordon, Verywell

Musculoskeletal-Related Causes of Neck Pain

Most cases of neck pain are due to a musculoskeletal problem.

Neck Strain

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 car accident) or from daily 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 Injury

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.

Besides neck pain, which may range in intensity from mild to severe, other symptoms of whiplash include:

  • Neck and shoulder muscle spasms
  • Reduced neck flexibility (range of motion)
  • Inability to move your neck
  • A headache (especially one at the back of your head)

Cervical Spondylosis

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
  • Sex
  • Smoking
  • Prior injury or trauma to the neck
  • A family history of the condition
  • Obesity
  • Depression or anxiety

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 head
  • Pain or odd sensations that move into the arm or shoulder, caused by the fraying of tough outer fibers (called the annulus fibrosus) of a disc
  • Headaches
  • A grinding feeling with neck movement
  • Weakness in the limbs
  • Numbness in the shoulders, arms, or hands
  • Balance problems
  • Bladder or bowel control problems
  • 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 spasms

Myofascial Pain

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.

The pain is usually deep and aching. It 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.

Neck Fracture

A fracture of one of the seven bones in the neck (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.

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.

Nerve-Related Causes of Neck Pain

In addition to musculoskeletal conditions, nerve problems may cause neck pain.

In many instances, a combination of nerve and musculoskeletal problems is the source of a person’s neck pain.

Cervical Radiculopathy

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, 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, a 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.

Other Causes of Neck Pain

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

Meningitis refers to inflammation of the meninges, which are tissues that line your brain and spinal cord.

The most common symptoms of meningitis include:

  • Stiff neck
  • Sudden fever
  • Severe headache
  • Double vision
  • Drowsiness
  • Light sensitivity
  • Confusion
  • Nausea or vomiting
  • In some cases, seizures

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

An uncommon but very serious infection of the cervical spine—either from bacteria, fungus, or tuberculosis—can also cause neck pain.

Three types of neck infections are:

  • 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 pain at night, is the most common symptom of a person with a cervical spine infection. Other symptoms include:

  • Neck stiffness
  • Weakness
  • Numbness
  • Low-grade fever
  • Chills
  • Night sweats

Rarely, an infection within the deeper tissue layers of the neck (called a deep space neck infection) may occur.

Symptoms other than neck pain can also be present depending on the location of the infection. For example, a person may have a sore throat, the inability to open their jaw (trismus), breathing difficulties, and trouble/pain with swallowing.

Cancer

Certain head and neck cancers, such as salivary gland cancer, may cause neck pain.

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 the 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.

Other symptoms include:

  • Pain in the neck or face, especially around the eyes
  • Headache
  • Small pupil on the affected side
  • Drooping eyelid on the affected side
  • Double vision
  • Whooshing sound in one ear
  • A sudden lack of sense of taste
  • Weakness on one side of the body
  • Dizziness
  • Vomiting

When to See a Healthcare Provider for Neck Pain

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, the pain is severe/worsening/persistent (not improving after one week), or the pain keeps you up at night.

If you have neck pain along with any of these symptoms, seek medical care as soon as possible:

  • Tingling, numbness, and/or weakness that moves down your arms or legs
  • A headache or dizziness
  • Vision problems
  • Lost control over your bladder or bowels
  • Loss of balance
  • Neck instability
  • Fever or chills
  • Weight loss

How Neck Pain Is Diagnosed

Diagnosing the cause of neck pain can be a difficult task. Even with the many tests and exams available to healthcare providers today, differentiating between likely causes can be challenging.

To start the diagnostic process, your healthcare provider will first determine whether your neck pain is traumatic or non-traumatic. Neck pain from acute trauma is usually seen in an emergency room and requires a faster pace of care.

Diagnosing Traumatic Neck Pain

If you experience trauma to your neck and are being treated by 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 some information that will be used to form a diagnosis.

Stabilization, Vitals, and Immobilization

In trauma situations, providers will do first aid and immobilize your neck with a backboard and rigid cervical collar with head supports on the sides. Once you’re stabilized, the team will check your vitals, which can provide clues into the seriousness of your condition.

In many instances of acute neck trauma, the emergency care team will then do imaging of your neck right away, instead of starting with the intensive, detailed medical history and exam that a person with non-traumatic neck pain would get.

Diagnosing Non-Traumatic Neck Pain

If you have not had a recent major neck trauma, your provider will begin taking your medical history and doing a detailed neck and neurological examination.

Medical History

During your medical history, your provider will ask about the intensity, duration, quality, and location of your neck pain.

They will also ask 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.

Neck Examination

For the physical exam, your provider will start by looking for signs of bruising, swelling, masses, or lumps. They will also look at your neck range of motion and press on your neck muscles to check for tenderness, spasms, and trigger points.

Neurological Examination

A neurological exam will be done in most cases of neck pain. After looking at your muscle strength, skin sensation, and reflexes, your provider may do some maneuvers or tests.

One test, called the Spurling test or maneuver, is very useful for showing the signs of cervical radiculopathy.

For the test, a provider presses on the top of a patient’s head and turns it toward the side of the neck pain. The test is positive if the maneuver reproduces the pain or other sensory disturbances like tingling.

Another maneuver your provider may do is called the Lhermitte’s sign. This test checks to see if a person gets a shock-like sensation where their neck is flexed.

If positive, the test suggests a possible cervical cord compression, which may happen with a herniated disc, bone spur, tumor, or multiple sclerosis lesion.

Imaging

Other than for acute neck trauma, imaging is generally only used for a person with findings on a physical exam that is associated with neck pain. It’s also used for people with “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 can look for cervical radiculopathy. An MRI of the cervical spine is also done to check for infection or malignancy.

A cervical spine X-ray and/or computed tomography (CT) scan can confirm a suspected neck fracture or diagnose cervical spondylosis.

Blood Tests

Blood tests, like a white blood cell count and blood cultures, might be done if your provider is worried that neck pain could be from meningitis or cervical spine infection.

Differential Diagnoses for Neck Pain

Neck pain does not always come from your neck. In fact, several medical conditions can either make you feel pain in your neck (referred pain) or cause neck pain and other symptoms.

For example, a gallbladder attack, rotator cuff tear, tension-type headache, migraine, and heart attack can cause pain to be felt in the neck. In these instances, there are usually other symptoms, too.

For example, with a migraine, visual disturbances (aura) come with throbbing, one-sided head pain, nausea and/or vomiting, and a sensitivity to light.

If your provider thinks you’re having a gallbladder attack, they can do an ultrasound and liver blood tests to check. If angina or a heart attack is suspected, an electrocardiogram (ECG) and cardiac enzymes (a blood test) will be done.

Sometimes, whole-body rheumatological conditions—such as fibromyalgia, rheumatoid arthritis, and polymyalgia rheumatica—cause neck pain. In these cases, there is usually pain in other parts of the body as well, not just the neck.

Certain blood tests, such as the inflammatory marker erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), can also help providers make a diagnosis.

How Neck Pain Is Treated

Treating your neck pain depends on the underlying cause 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 the pain. This can be followed by applying moist heat—like a warm bath or shower—to your neck to loosen tight muscles.

Medications

For musculoskeletal or nerve-related neck pain, certain medications might be recommended by your provider including muscle relaxants, nonsteroidal anti-inflammatories (NSAIDs), and Tylenol (acetaminophen).

If your pain is severe, you might need prescription medications for pain like opioids. Oral steroids (e.g., prednisone) or a steroid injection (cortisone) might be recommended for cervical radiculopathy or central cord syndrome. Steroids work to alleviate pain, as well as reduce inflammation.

For meningitis or a neck infection, antibiotics and/or anti-viral or anti-fungal medications will be given to you through a vein (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.

Physical Therapy

For neck strains and cervical radiculopathy, your physical therapist may have you do 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 might be recommended for short periods of time.

Complementary Therapies

Sometimes complementary therapies are used in conjunction with traditional medications or therapies to alleviate discomfort.

For instance, massage therapy, acupuncture, or biofeedback can be helpful for neck strains. Trigger point injections can be used to treat myofascial pain.

Surgery

Surgery is not commonly used to treat neck pain, but it might be necessary for certain situations.

For example, with persistent or severe cases of cervical radiculopathy, there are three surgeries that can be done:

  • 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

An angioplasty with or without stent placement is needed to repair a dissected cervical artery. This type of surgery is usually done by an interventional cardiologist or vascular surgeon.

How to Prevent Neck Pain

It’s not possible to prevent every kind of neck pain, especially those related to age (e.g., cervical spondylosis). However, there are some things you can do to help manage pain and minimize your chances of getting neck trauma or injury in the first place.

  • Maintain proper posture: For example, if you look at a computer for long periods, you can reduce the tension in your neck by sitting at eye level with your screen and taking occasional breaks to stand up and stretch.
  • Alleviate stress: Consider relaxation techniques or mindfulness meditation.
  • Talk with your healthcare provider about the best sleeping position for you: For example, they may recommend avoiding sleeping on your stomach. You can also try using a neck roll, rather than a pillow.
  • Buckle up: Always be sure to wear your seat belt and make sure you’re wearing it 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 avoid reaching for things and make changes in your living space to minimize your risk for falls.

Summary

Neck pain can be an acute problem caused by an injury (like whiplash), or a chronic condition that develops and may get worse over time (like arthritis in the spine). Providers can use a combination of exams and tests to figure out the cause of neck pain and recommend the best treatment.

Some of the common ways to treat neck pain include OTC and prescription medications for pain and physical therapy. Some causes of neck pain are more serious and need to be treated with surgery.

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