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Neck Pain


Peter J. Moley

, MD, Hospital for Special Surgery

Last full review/revision Nov 2020| Content last modified Nov 2020
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Along with low back pain, neck pain is a very common reason for health care visits. The pain usually results from problems with the musculoskeletal system—the spine, including the bones of the spine (backbones, or vertebrae) and the muscles and ligaments that support it. Some disorders cause only neck pain. Other disorders can cause neck and low back pain. Occasionally, neck pain results from a disorder, such as meningitis, that does not involve the musculoskeletal system.

The neck's flexibility makes it susceptible to wear and tear and to injuries that overstretch it, such as whiplash. Also, the neck has the critical job of holding up the head. Poor posture makes that job more difficult. Thus, neck pain, like back pain, is common and becomes more common as people age. For pain located in the front of the neck, see Sore Throat.

The part of the spine that is in the neck is called the cervical spine. It consists of seven back bones (vertebrae), which are separated by disks made of jelly-like material and cartilage. The cervical spine contains the spinal cord. Along the length of the spinal cord, spinal nerves emerge through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is the spinal nerve root. Muscles and ligaments in the neck support the spine.

Neck pain can involve damage to bones, muscles, disks, or ligaments, but pain can also be caused by damage to nerves or the spinal cord. A spinal nerve root can be compressed when the spine is injured, resulting in pain and sometimes weakness, numbness, and tingling in an arm. Compression of the spinal cord can cause numbness and weakness of both arms and both legs and sometimes loss of bladder control (urinary incontinence) and bowel control (fecal incontinence).

Causes of Neck Pain

Most of the disorders that can cause low back pain can also cause neck pain, and most involve the spine, the tissues that support it, or both.

Common causes

Common causes of neck pain include

Spasms of the neck muscles are common and may occur on their own or after an injury, even a minor injury.

In cervical spondylosis, the vertebrae in the neck and the disks between them degenerate, usually because of osteoarthritis. As a result, the nerves that emerge through the vertebrae may be pinched. Sometimes the spinal canal is narrowed (cervical spinal stenosis), and the spinal cord is compressed.

Cervical spinal stenosis describes the condition in which the space inside the spine canal becomes narrowed. In the cervical spine this results in compressing the thecal sac, often the spinal cord, and/or its nerve roots. The usual cause is a combination of osteoarthritis, disk degeneration, and thickening of the soft tissues in the neck.

Herniated disks can cause neck pain. The disks between each of the vertebrae have an outer layer of cartilage (a tough, fiber-like tissue) and a soft, jelly-like interior. If a disk is repeatedly squeezed by the vertebrae above and below it, the outer layer may tear (rupture), causing pain. The interior of the disk can bulge out through the tear (herniate). The bulging disk can push on or even damage the spinal nerve root next to it. Rarely, the disk compresses the spinal cord.

Injuries may occur during routine activities (for example, lifting, exercising, moving in an unexpected way) or result from trauma such a fall or car crash. Often no specific injured structures are identified with imaging tests, but doctors presume that some muscles and/or ligaments have been affected.

Fibromyalgia is a common cause of pain, sometimes including neck pain. This disorder causes chronic widespread pain in muscles and other soft tissues in areas besides the neck.

Less common causes

Less common causes of neck pain that are serious include

Spasmodic torticollis is also a less common cause but is not as serious as some causes. It is a severe type of spasm of a specific neck muscle that causes the head to tilt and rotate into an abnormal position. Sometimes the spasms are rhythmic, causing the head to jerk. The cause may be unknown or may be due to certain drugs or hereditary disorders.

Evaluation of Neck Pain

The following information can help people with neck pain decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In the evaluation, doctors first try to identify serious disorders.

Warning signs

In people with neck pain, certain signs are cause for concern. They include

  • Loss of strength or sensation in the arms and legs—possibly a symptom of nerve damage

  • Fever

  • Night sweats

  • Headache

  • Lethargy or confusion

  • Chest discomfort

  • Sudden sweating or difficulty breathing

  • Pain that is triggered by exertion or worsens during exertion

When to see a doctor

People with warning signs or difficulty or pain when swallowing should see a doctor immediately.

If people without warning signs have severe pain (particularly if it is not relieved by acetaminophen or a nonsteroidal anti-inflammatory drug [NSAID]), they should see a doctor within a day or so.

Other people can wait a few days or call their doctor to discuss how soon they need to be seen.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and examination often suggests a cause of the neck pain and the tests that need to be done (see Table: Some Causes and Features of Neck Pain).

The physical examination focuses on the spine and nervous system (neurologic examination) to look for signs of nerve root or spinal cord compression. Signs of nerve root compression include muscle weakness, abnormal reflexes (tested by tapping the tendons around the elbow and wrist), decreased sensation in parts of the body other than the head, inability to urinate, and incontinence of urine or incontinence of stool. Doctors may ask the person to move the neck in certain ways.

With information about the pain, the person’s medical history, and results of a physical examination, doctors may be able to determine the most likely causes:

  • Loss of strength or sensation may indicate damage to the spinal cord or nerves exiting from the cervical spine.

  • Pain on the front or on one side of the neck usually is not caused by a problem with the spinal cord.

  • Neck pain that radiates down an arm is usually caused by cervical disk herniation or spondylosis with compression of the spinal nerve root.

  • Pain in the chest that travels up into the neck or into the arm may be caused by a heart disorder such as angina or a heart attack.

  • Pain that is constant, severe, progressively worse, and unrelieved by rest, particularly if it keeps the person awake at night and is accompanied by sweating, may indicate cancer or an infection.


Some Causes and Features of Neck Pain


Common Features*


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)


Progressively worsening, constant pain (even at night), regardless of position or movement

Sometimes night sweats or weight loss


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


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.

CT = computed tomography; MRA = magnetic resonance angiography; MRI = magnetic resonance imaging.


Often, testing is not necessary because most neck pain is caused by muscle spasm and strains, which doctors can typically diagnose based on the examination. Testing is usually done if doctors suspect certain other disorders (see Table: Some Causes and Features of Neck Pain).

If people have symptoms of nervous system malfunction (neurologic symptoms), such as weakness or numbness, magnetic resonance imaging (MRI) or computed tomography (CT) is usually done. MRI provides clearer images of soft tissues (including disks and nerves) than CT. CT provide better images of bones than plain x-rays. However, plain x-rays can often identify common abnormalities in bone (such as arthritis), so if doctors suspect such an abnormality, x-rays may be done first.

Occasionally, electromyography and nerve conduction studies are done to evaluate possible nerve root compression or to determine an alternative explanation for weakness or tingling and numbness.

Treatment of Neck Pain

Specific disorders are treated.

General measures for neck pain

Measures include

  • Taking drugs that relieve pain

  • Applying heat or cold to the painful area

  • Modifying activities

  • Light exercise as tolerated

Most often, a sprain, muscle spasm, or other musculoskeletal injury is the cause of neck pain, and an over-the-counter analgesic, such as acetaminophen or an NSAID, to relieve the pain is all that is needed. Symptoms usually resolve completely. If inflammation is not contributing to the pain (as with sprains, spasms, and other injuries), acetaminophen can be used because it is thought to be safer than NSAIDs. Ice or heat may also help (see Treatment of Pain and Inflammation).

If more pain relief is needed, doctors may prescribe opioid analgesics, but, if prescribed, opioids should be used only for a short duration because long-term use of opioid analgesics can actually increase sensitivity to pain and cause side effects, such as drowsiness, confusion, and constipation, and risk the development of a substance use disorder. Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes used, but their usefulness is controversial. Muscle relaxants are not recommended for older people, who are more likely to have side effects.

Avoiding aggravating activities, such as sitting for extended periods of time (particularly when also using a computer, phone, or other electronic device), may help. Using good posture and body mechanics when standing, sitting, lying down, or doing any activity is important. People are taught how to stand, sit, and sleep in ways that do not strain the neck. People who sleep on their side should use a pillow to support the head and neck in a neutral position (not tilted down toward the bed or up toward the ceiling). People who sleep on their back should use a pillow to support, but not raise, the head and neck. People should avoid sleeping on their stomach. People may also wear a neck brace (cervical collar) to keep the neck still and help relieve pain. Doctors or physical therapists may suggest stretching and strengthening exercises, including strengthening exercises for the upper back.

Other measures to reduce neck pain

People with pain that radiates into one arm and involves symptoms of nerve damage, such as arm and leg weakness, may require more intensive treatment. Traction can help. Corticosteroids, given orally and occasionally by epidural injection, have been used to reduce symptoms.

For spasmodic torticollis, physical therapy or massage can sometimes temporarily stop the spasms. Drugs (including the antiseizure drug carbamazepine and some mild sedatives such as clonazepam, taken by mouth) can usually relieve the pain. But drugs control spasms in only about one third of people. If the pain is severe or if posture is distorted, botulinum toxin (a bacterial toxin used to paralyze muscles) may be injected into the affected muscles.

Surgery for neck pain

People who have a compressed spinal cord or spinal nerve due to a herniated disk in the neck and severe weakness or pain may require surgery. Surgical removal of the disk (diskectomy) and surgery to fuse vertebrae together (called cervical or spinal fusion) are the most common treatments. However, success rates are about the same for people who are treated with either nonsurgical or surgical options. The effectiveness of surgery for neck pain due to other disorders depends on the cause.

Key Points about Neck Pain

  • Most neck pain is caused by sprains and muscle spasms and resolves completely.

  • Many of the disorders that can cause low back pain can cause neck pain.

  • People with warning signs, such as numbness or arm and leg weakness, should see a doctor immediately.

  • Most neck pain can be relieved by over-the-counter analgesics and modification of activities.

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Spondyloarthritis refers to a group of connective tissue diseases that cause prominent joint inflammation. Ankylosing spondylitis is a type of spondyloarthritis characterized by inflammation of the spine, large joints, and fingers and toes, resulting in stiffness and pain. Which of the following groups is most likely to develop ankylosing spondylitis?
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