Symptoms

The precise location and severity of your neck pain provides important clues in determining what might be causing it. Make sure to tell your doctor if any head or neck movements make your neck pain better or worse.

When to see a doctor
Neck pain doesn't always require medical care. But in rare cases, it can be a sign of an emergency. Seek immediate medical care if you experience:

• Shooting pain into your shoulder or down your arm
• Numbness or loss of strength in your arms or hands
• Change in bladder or bowel habits
• Inability to touch your chin to your chest

Causes

Neck pain can result from a variety of causes, ranging from overuse injuries and whiplash to diseases such as rheumatoid arthritis and meningitis.

Muscle strains
Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.

Worn joints
Just like all the other joints in your body, your neck joints tend to experience wear and tear with age, which can cause osteoarthritis in your neck.

Nerve compression
A variety of problems in your neck's vertebrae can reduce the amount of space available for nerves to branch out from the spinal cord. Examples include:

• Stiffened disks. As you age, the cushioning disks between your vertebrae become dry and stiff, narrowing the spaces in your spinal column where the nerves exit.
• Herniated disks. This occurs when the inner gel-like material of a disk protrudes through the disk's tougher outer covering. The protrusion can press on nerves exiting the spinal column, causing arm pain or weakness, or on the spinal cord itself.
• Bone spurs. Arthritic joints in your neck can develop bony growths that may press on nerves.

Injuries
Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and then backward, stretching the soft tissues of the neck beyond their limits.

Diseases
Neck pain can sometimes be caused by diseases, such as:

• Rheumatoid arthritis. After the joints in the hands and the feet, the joints in the neck are the next most commonly affected by rheumatoid arthritis.
• Meningitis. This infectious disease causes the lining of the brain and spinal cord to swell. One of the most common symptoms of meningitis is neck pain and stiffness.
• Cancer. Rarely, neck pain can be caused by cancerous tumors in the spine. The cancer may have traveled to the spine from other parts of your body.

Risk factors

Risk factors for neck pain include:

• Age. The neck is often affected by the wear-and-tear variety of arthritis (osteoarthritis), which becomes more common with age.
• Occupation. Your risk of neck pain may be higher if your job requires your neck to be held in one position for prolonged periods of time. Examples include driving and computer work.

Preparing for your appointment

While you may initially consult your family doctor about your neck pain, he or she may refer you to:

• A rheumatologist, a doctor who specializes in arthritis and other diseases that affect the joints
• A neurologist, a doctor who specializes in treating nerve-related disorders
• An orthopedic surgeon, a doctor who operates on bones and joints

What you can do
Before your appointment, you may want to write a list that answers the following questions:

• How long has your neck been hurting?
• Is the pain dull, sharp or shooting?
• Do any particular neck movements make the pain improve or worsen?
• Do you have any numbness or weakness?
• Does the pain radiate into the arm?
• Have you injured your neck recently?
• What medications and supplements are you taking?

What to expect from your doctor
During the physical exam, your doctor will check for:

• Tenderness. Pressing on various spots on your neck, head and shoulders helps reveal areas of tenderness.
• Range of motion. This exam involves moving your head as far as it can go forward, backward and side to side. The doctor may also check to see if the movements of your shoulders have been impaired.
• Numbness or weakness. Areas of numbness or muscle weakness may indicate that your spinal cord or a nerve exiting your spinal cord is being pinched.

Tests and diagnosis

Your doctor often will be able to diagnose the cause of your neck pain and recommend treatment just by asking questions about the type, location and onset of your pain. In some instances, however, imaging tests, nerve tests or lab tests may be warranted.

Imaging tests

• X-rays. X-rays can reveal areas in your neck where your nerves or spinal cord may be pinched by bone spurs or a bulging disk. But many people, especially those over 60, have these findings and don't experience any neck pain.
• Computerized tomography (CT). CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.
• Magnetic resonance imaging (MRI). MRIs utilize radio waves and a strong magnetic field to create especially detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.

Nerve tests
If your doctor suspects that your neck pain may be related to a pinched nerve, he or she may suggest electromyography (EMG). This test involves inserting very fine needles through your skin into a muscle to determine whether specific nerves are functioning properly.

Lab tests

• Blood tests. Blood tests can sometimes provide evidence of inflammatory or infectious conditions that may be causing your neck pain.
• Spinal tap (lumbar puncture). During a spinal tap, a needle is carefully inserted into your spine to obtain a sample of the fluid that surrounds your brain and spinal cord. This test can reveal evidence of meningitis.

Treatment and drugs

The most common types of neck pain usually respond well to home care. If neck pain persists, your doctor may recommend other treatments.

Medications

• Pain medications. Your doctor may prescribe stronger pain medicine than what you can get over-the-counter. Opioid analgesics are sometimes used briefly to treat acute neck pain. Muscle relaxants, tramadol (Ultram) or tricyclic antidepressant medications used for pain also may be prescribed.
• Injections of medication. Injections of medications may help relieve neck pain. Your doctor may inject corticosteroid medications near the nerve roots, into the small facet joints in the bones of the cervical spine, or into the muscles in your neck to help with pain. Numbing medications, such as lidocaine, also can be injected to relieve your neck pain.

Therapy

• Neck exercises and stretching. Your doctor may recommend that you work with a physical therapist to learn neck exercises and stretches. A physical therapist can guide you through these exercises and stretches so that you can do them on your own at home. Exercises may improve pain by restoring muscle function, optimizing posture to prevent overload of muscle, and increasing the strength and endurance of your neck muscles.
• Traction. Traction uses weights and pulleys to gently stretch your neck and keep it immobilized. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation.
• Short-term immobilization. A soft collar that supports your neck may help relieve pain by taking pressure off the structures in your neck. If used for more than two weeks, however, a collar may do more harm than good.

Surgical and other procedures
Surgery is rarely needed for neck pain. However, it may be an option for relieving nerve root or spinal cord compression.

Lifestyle and home remedies

Self-care measures you can try at home to relieve neck pain include:

• Over-the-counter pain relievers. Try over-the-counter pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others).
• Alternate heat and cold. Reduce inflammation by applying cold, such as an ice pack or ice wrapped in a towel, for up to 20 minutes several times a day. Or alternate the cold treatment with heat. Try taking a warm shower or using a heating pad on the low setting. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution.
• Rest. Lie down from time to time during the day to give your neck a rest from holding up your head. Avoid prolonged rest, since too much inactivity can cause increased stiffness in your neck muscles.
• Gentle stretching. Gently move your neck to one side and hold it for 30 seconds. Stretch your neck in as many directions as your pain allows. This may help alleviate some of the pain.

Alternative medicine

Talk to your doctor if you're interested in trying alternative treatments for your neck pain. Your doctor can discuss the benefits and risks. Alternative treatments include:

• Acupuncture. Acupuncture involves the insertion of thin needles into various points on your body. Studies have found that acupuncture may be helpful for many types of pain. But studies in neck pain have been mixed. For best results, you may need to undergo several acupuncture sessions. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles. But don't undergo acupuncture treatment if you're taking blood thinners.
• Chiropractic. Given mainly to the spine, a chiropractic adjustment applies a controlled, sudden force to a joint — moving it beyond its normal range of motion. Chiropractic treatments to the neck may slightly increase your risk of stroke.
• Massage. During a massage, a trained practitioner manipulates the muscles in your neck with his or her hands. Little scientific evidence exists to support massage in people with neck pain, though it may provide relief when combined with your doctor's recommended treatments.
• Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.

Prevention

Most neck pain is associated with poor posture on top of age-related wear and tear. To help prevent neck pain, keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help. Consider trying to:

• Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
• Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
• Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
• Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
• Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
• Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.