Neck Pain

By David A. Thompson, M.D. 
March 22, 2017

911 warning

Neck Pain

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Does this describe your symptoms?


  • Pain in the back, side or front of the neck

Common Causes

  • Muscle Strain: New onset neck pain is often from strained neck muscles caused by sleeping in an awkward position; cradling the telephone between neck and shoulder for an extended conversation; painting a ceiling; reading in bed; reaching for something that was difficult to get; sitting in the front row of a movie theater; looking at something that requires extreme bending or turning of neck; prolonged typing; and so on.

  • Muscle Tension/Spasm: Muscle tension neck pain is one of the most common causes of new onset neck pain. It is seen in every age group and is related to stressful situations in the workplace and at home. The pain may radiate (shoot, spread) into the upper back and into the scalp. Frequently, individuals with this type of muscle tension neck pain will report that the discomfort is worse toward the end of the day. Therapy for this type of pain should be directed at stress reduction, good posture, and gentle neck exercises.

If not, see these topics


When to Call Your Doctor

call 911

Call 911 Now (you may need an ambulance) If

  • Very weak (can't stand)

call now

Call Your Doctor Now (night or day) If

  • You feel weak or very sick

  • Fever and stiff neck (can't touch chin to chest)

  • Headache and stiff neck (can't touch chin to chest)

  • Weakness in the arms or legs

  • Numbness or tingling in arms, upper back or legs

  • Problems with bowel or bladder control

  • Difficulty breathing or unusual sweating (e.g., sweating without exertion)

  • Chest pain

  • Intravenous drug abuse

  • Head is twisting to one side (i.e., turning against your will)

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think you need to be seen

  • You have a history of cancer, HIV, or intravenous drug abuse

  • Tenderness or swelling of front of neck over windpipe

  • Neck pain radiates (shoots, spreads) into the arm or hand

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Neck pain lasts more than 2 weeks

  • Neck pains are a recurrent problem

  • Over 50 years old and you have not experienced similar neck pain previously

  • Neck pain lasts more than 3 days and it interferes with normal activities or awakens from sleep

home care

Self Care at Home If

  • Mild neck pain and you don't think you need to be seen



  1. Reassurance: Prolonged turning of the head or working in an awkward position can cause muscle pain in the back of the neck. With treatment, the pain usually resolves in 1 to 2 weeks.

  2. Local Cold Or Heat: During the first 2 days after a mild injury, apply a cold pack or an ice bag (wrapped in a towel) for 20 minutes four times a day. After 2 days, apply a heating pad or hot water bottle to the most painful area for 20 minutes whenever the pain flares up. Wrap hot water bottles or heating pads in a towel to avoid burns.

  3. Sleep: Sleep on your back or side, not the abdomen. Sleep with a neck collar - use a foam neck collar (from a pharmacy) OR a small towel wrapped around the neck (Reason: keep the head from moving too much during sleep).

  4. Stretching Exercises:

    • After 48 hours of protecting the neck, begin gentle stretching exercises.

    • Improve the tone of the neck muscles with 2 or 3 minutes of gentle stretching exercises per day such as touching the chin to each shoulder, touching the ear to each shoulder, and moving the head forward and backward.

    • Don't apply any resistance during these stretching exercises.

  5. Pain Medicines:

    • For pain relief, take acetaminophen, ibuprofen, or naproxen.

    Acetaminophen (e.g., Tylenol):

    • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.

    • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.

    • The most you should take each day is 3,000 mg.

    Ibuprofen (e.g., Motrin, Advil):

    • Take 400 mg by mouth every 6 hours.

    • Another choice is to take 600 mg by mouth every 8 hours.

    • Use the lowest amount that makes your pain feel better.

    Naproxen (e.g., Aleve):

    • Take 250-500 mg by mouth every 12 hours.

    • Use the lowest amount that makes your pain feel better.

    Extra Notes:

    • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.

    • Caution: Do not take acetaminophen if you have liver disease.

    • Caution: Do not take ibuprofen or naproxen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of medicine. Do not take ibuprofen or naproxen for more than 7 days without consulting your doctor.

    • Before taking any medicine, read all the instructions on the package

  6. Good Body Mechanics:

    • Lifting: Stand close to the object to be lifted. Keep your back straight and lift by bending your legs. Ask for help if needed.

    • Sleeping: Sleep on a firm mattress.

    • Sitting: Avoid sitting for long periods of time without a break. Avoid slouching. Place a pillow or towel behind your lower back for support.

    • Computer screen: place at eye level.

    • Posture: Maintain good posture.

  7. Avoid: Avoid triggers that overstress the neck such as working with the neck turned or bent backward, carrying heavy objects on the head, carrying heavy objects with one arm (instead of both arms), standing on the head, contact sports or even friendly wrestling.

  8. Call Your Doctor If:

    • Numbness or weakness occurs

    • Bowel or bladder problems occur

    • Pain persists for more than 2 weeks

    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.


March 22, 2017