Stiff Neck

A stiff neck may occur by itself or with other symptoms, which vary depending on the underlying cause, your medical history, and other factors. Additional symptoms that may occur with a stiff neck include:

• Difficulty turning your head

• Difficulty opening or closing the mouth

• Headache

• Irritability

• Pain down your shoulders or arms

• Sleep disturbances

In some cases, neck stiffness or pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as meningitis, heart attack, or spinal trauma, which should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) for a stiff neck or neck discomfort with any of these symptoms:

• Abnormal pupil size or nonreactivity to light

• Chest pain, tightness or pressure

• Difficulty breathing or shortness of breath

• Difficulty swallowing

• Droopy eyelid

• Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)

• Jaw pain

• Nausea and vomiting

• Neck stiffness that prevents you from touching your chin to your chest

• Numbness or change in sensation

• Paralysis or difficulty moving any area of your body

• Rash

Conditions that originate in the neck itself can cause a stiff neck, as can diseases and conditions of related areas, such as the shoulders, jaw, head, or upper arms. A stiff neck often occurs due to factors that cause a strain of the neck or shoulder muscles, such as sleeping in awkward positions, poor posture, or strenuous activities. The levator scapulae are the muscles at the back and side of the neck. They connect the neck to the shoulder on either side. As a result of its position and the forces acting upon it, you can strain this muscle easily.

Neck stiffness and discomfort can also be caused by diseases, disorders and conditions of any of the structures that make up the neck. This includes the cervical spine and spinal cord, nerves, intervertebral discs, muscles, ligaments, tendons, thyroid gland, trachea, and throat. Referred pain from disorders within the chest or abdomen can also generate neck stiffness.

A stiff neck may be due to muscle strains, ligament sprains, and other musculoskeletal problems. Causes include:

• Activities involving repeated side-to-side turning of the head

• Cervical spine fracture or spinal cord trauma

• Excessive stress or tension

• Holding the neck in an abnormal position or immobile for long periods

• Injuries, falls, or other trauma, such as a motor vehicle accident or sports injury

• Osteoarthritis (type of arthritis characterized by degeneration of the cartilage and bone in the joints) and rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)

• Poor posture

• Sleeping or resting in an awkward position

• Spinal degeneration (spondylosis, a degenerative disc disease)

• Spinal stenosis (narrowing of the spinal canal causing pressure on the spinal cord or nerves), which can be caused by a herniated disc in the neck and other conditions

• Whiplash (cervical sprain or strain, neck hyperextension followed by hyperflexion)

Diseases or conditions that can affect the neck include:

• Arthritis

• Brain aneurysm (cerebral aneurysm, a bulging of the wall of a brain artery)

• Cancer, including spinal tumors and multiple myeloma (a type of blood cancer)

• Carotid artery dissection (arterial blood reroutes into the layers of the carotid artery wall)

• Fibromyalgia (chronic condition that causes pain, stiffness and tenderness)

• Headache, such as migraine

• Heart attack

• Infections, such as influenza (flu), cervical spine infection, or meningitis (a serious bacterial infection of the membranes surrounding the brain and spinal cord)

• Osteomyelitis (infection or inflammation of the spinal bones)

• Referred pain from diaphragm, gallbladder, or stomach conditions

• Temporal arteritis (giant cell arteritis)

• Temporomandibular joint pain

• Thyroiditis

A stiff neck is commonly the result of muscle strain or tension. This kind of neck stiffness usually resolves on its own within a few days. However, there are times when it is best to see a doctor to find out if something more serious is to blame.

See a doctor promptly when:

• Neck stiffness interferes with your daily activities or sleep.

• Neck stiffness persists for a week or worsens despite home care.

• Neck stiffness occurs with pain that radiates or spreads down the arms or legs.

• You also have a headache or numbness, tingling or weakness in your arm or hand.

• You have had a tick bite within the last month.

Call 911 or go to your nearest emergency room for neck stiffness when:

• Neck stiffness occurs with severe neck pain, loss of coordination, or difficulty walking or using an arm or leg.

• Neck stiffness accompanies difficulty swallowing, extreme drowsiness, flu-like symptoms, skin rash, or vomiting.

• You experience a sudden change of vision or notice a droopy eyelid

• You have a fever and headache or you cannot bend your neck toward your chest.

• You have had a neck injury or trauma to the neck or shoulders, such as a diving accident or fall.

• You have symptoms of a heart attack, such as chest pain or discomfort, arm or jaw pain, shortness of breath, or sweating.

• You lose bladder or bowel control.

To diagnose the cause of neck stiffness, your doctor will take a medical history, perform an exam, and possibly order testing. As part of the medical history, your doctor may ask several questions about your neck stiffness including:

• In what part of the neck do you feel stiffness?

• When did the stiffness start?

• Is your neck always stiff or does the stiffness come and go?

• What, if anything, seems to make the stiffness better or worse?

• Do you have neck pain? If so, how would you describe it and how severe is it?

• Have you experienced any recent trauma or injury, such as a sports injury or motor vehicle accident?

• Have you had a recent tick bite or spent time outdoors in a high-risk tick area?

• Are you experiencing any other symptoms, such as fever, headache or numbness?

During the physical exam, your doctor will be looking for areas of tenderness, numbness or weakness. Your doctor may have you try to move your head in different directions, from side to side and front and back. This will check the range of motion of your neck muscles. Depending on the results, your doctor may order testing including:

• Blood tests to check for signs of infection or inflammation

• Electromyography (EMG) to test how well your nerves communicate with your muscles

• Imaging exams, including X-rays, CT (computed tomography) scans, and MRIs (magnetic resonance imaging)

• Lumbar puncture, or spinal tap, to take a sample of CSF (cerebrospinal fluid) to check for meningitis

It is not always possible to diagnose an underlying cause or condition. If neck stiffness persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

Treating neck stiffness depends on the underlying cause of the problem. In most cases, a stiff neck due to muscle strain or tension usually responds to self-care at home. Other causes may require more intense treatments. Depending on the cause, your doctor may recommend the following:

• Antibiotics

• Anti-inflammatory medicines, such as corticosteroids

• Muscle relaxants or pain relievers, which may include tricyclic antidepressants

• Physical therapy to improve posture and alignment and strengthen and stretch neck muscles

• Soft neck collar, which you wear for only short periods of time to avoid weakening your neck muscles

Surgery may be an option for certain causes of a stiff neck.

Most people will experience a stiff neck from time to time. Everyday muscle strain or tension is usually the cause. This type of neck stiffness will most likely resolve on its own with care at home using a stiff neck remedy or two. Self-care for neck stiffness includes:

• Applying ice for the first 48 hours, then heat therapy, such as a heating pad or warm compress

• Learning a stiff neck exercise routine to stretch the neck, including slowly bringing your ear to shoulder, turning your head to the side, rolling your shoulders, and squeezing your shoulder blades

• Massaging the muscles 

• Practicing good posture

• Sleeping on your side or back, not sleeping on your stomach, and using a neck pillow to sleep

• Taking over-the-counter pain relievers, including acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)

Neck stiffness due to overuse or minor strains usually responds to home treatments, such as rest, ice, and over-the-counter anti-inflammatory medications. However, in some cases, neck stiffness may become a chronic condition and affect your daily life. Over time, neck stiffness can lead to complications including:

• Absenteeism from work or school

• Adverse effects of treatment

• Chronic pain

• Disability

• Paralysis

• Poor quality of life

• Spread of cancer

• Spread of infection