Neck pain

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Pain - neck; Neck stiffness

Considerations

Neck pain may originate from any of the structures in the neck. These include muscles and nerves as well as spinal vertebrae and the cushioning discs in between. Neck pain may also come from regions near the neck, like the shoulder, jaw, head, and upper arms.

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

If neck pain involves nerves (for example, significant muscle spasm pinching on a nerve or a slipped disc pressing on a nerve), you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere.

Common Causes

A common cause of neck pain is muscle strain or tension. Usually, everyday activities are to blame. Such activities include bending over a desk for hours, having poor posture while watching TV or reading, placing your computer monitor too high or too low, sleeping in an uncomfortable position, or twisting and turning the neck in a jarring manner while exercising.

Traumatic accidents or falls can cause severe neck injuries like vertebral fractures, whiplash, blood vessel injury, and even paralysis.

Other causes include herniated disc, fibromyalgia (pain syndrome throughout the body), and arthritis. Meningitis, although much less common, can cause significant neck stiffness.

Home Care

For minor, common causes of neck pain:

• Take acetaminophen or ibuprofen.
• Apply heat or ice to the painful area. One good method is to use ice for the first 48 - 72 hours, then use heat after that. Heat may be applied with hot showers, hot compresses, or a heating pad. Be careful not to fall asleep with a heating pad on.
• Perform slow range-of-motion exercises -- up-and-down, side-to-side, and from ear-to-ear -- to gently stretch the neck muscles.
• Have a partner gently massage the sore or painful areas.
• Try sleeping on a firm mattress without a pillow or with a special neck pillow.

Call your health care provider if

• One week of self care hasn't helped.
• 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 911 or get to a hospital.
• 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 respond to standard doses of over-the-counter pain medication.

What to expect at your health care provider's office

Your doctor will perform a physical examination and ask detailed questions about your neck pain, such as:

• Is your pain in the front, back, or side of your neck?
• Are both sides of your neck affected equally?
• When did the pain first develop?
• Is it painful all the time or does pain come and go?
• Can you touch your chin to your chest?
• What makes your neck feel worse? What makes your neck feel better?
• Do you have neck weakness or neck stiffness?
• Do you have any accompanying symptoms like numbness, tingling, or weakness in your arm or hand?
• Do you have swollen glands or a lump in your neck?

The following diagnostic tests may be performed:

• X-rays of the neck
• CT scan of the neck or head
• Blood tests such as a complete blood count or a thyroid test
• A spinal tap for a cerebrospinal fluid analysis if meningitis is suspected
• Occasionally, an MRI of the neck

If the pain is due to muscle spasm or a pinched nerve, your doctor may prescribe a muscle relaxant and possibly a more powerful pain reliever. Prescription drugs are not necessarily better than over-the-counter medications. The doctor may prescribe a neck collar or, if there is nerve damage, refer you to a neurologist or neurosurgeon for consultation.

If meningitis is suspected, you will be sent to an emergency department for further tests, antibiotics, and hospital admission.

If a thyroid condition is considered (due, for example, to a lump in the front of your neck), follow-up care for abnormal blood tests will be needed.

Prevention

• Use relaxation techniques and regular exercise to prevent unwanted stress and tension to the neck muscles.
• Learn stretching exercises for your neck and upper body. Stretch every day, especially before and after exercise. A physical therapist can help.
• If you tend to get neck pain from exercise, apply ice to your neck after physical activity.
• Use good posture, especially if you sit at a desk all day. Keep your back supported. Adjust your computer monitor to eye level. This prevents you from continually looking up or down.
• If you work at a computer, stretch your neck every hour or so.
• Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
• When reading or typing from documents at your desk, place them in a holder at eye level.
• Evaluate your sleeping conditions. Make sure your pillow is properly and comfortably supporting your head and neck. You may need a special neck pillow. Make sure your mattress is firm enough.
• Use seat belts and bike helmets to prevent injuries.

References

Kasch H, Bach FW, Stengaard-Pedersen K, Jensen TS. Development in pain and neurologic complaints after whiplash: A 1-year prospective study. Neurology. 2003; 60: 743 - 749.

Devereaux MW. Neck pain. Prim Care. 2004; 31(1): 19-31.

Phero JC. Pharmacological management of head and neck pain. Otolaryngol Clin North Am. 2003; 36(6): 1171-1185.

Illustrations

Neck pain