Neck pain: causes, treatment and when to see a doctor

The NHS lists the most common causes as the neck becoming locked in an awkward position while sleeping, bad posture (for example sitting at a desk for a long time), a pinched nerve and an injury such as whiplash from a traffic accident or fall.

Arthritis UK (formerly Versus Arthritis) adds worry or stress, sleeping awkwardly, a sprain or strain and a flare-up of cervical spondylosis, which it says can happen as the discs and joints in the spine age. It says many people develop a stiff and painful neck for no obvious reason, sometimes after sitting in a draught or a minor twisting injury, which is called non-specific neck pain. This is the most common type and usually disappears after a few days.

The NHS says cervical spondylosis is a normal part of ageing for many people over 40 and that many people with it have no symptoms. It can cause neck and shoulder pain or stiffness that comes and goes, and headaches that often start at the back of the neck.

The NHS suggests the following. It says to try either a pack of frozen peas wrapped in a tea towel for 5 minutes, 3 times a day, or a hot water bottle wrapped in a tea towel for 20 minutes, 2 to 3 times a day.

• Take paracetamol or ibuprofen, or use ibuprofen gel on your neck.

• Use a low, firm pillow.

• Put heat or cold packs on your neck.

• Try neck flexibility exercises.

• Do not wear a neck collar; it is better to keep your neck moving unless a doctor tells you not to.

• Do not do anything that could be dangerous because you cannot move your neck, such as driving or cycling.

Arthritis UK says simple self-help treatments and a day or two's rest are often enough, and that physiotherapists, chiropractors and osteopaths are all trained to treat neck problems, usually alongside home exercises. It stresses that physical treatments should be given by qualified practitioners registered with the relevant body.

If pain is not settling, a doctor may prescribe stronger painkillers or amitriptyline, which in lower doses can relax muscles and improve sleep. Gabapentin or pregabalin may help if a pinched nerve is causing arm pain. Arthritis UK describes injections into the neck joints and radiofrequency denervation as options used in a very small minority of people after other treatments have failed, and says surgery is only rarely needed, for example if a nerve or the spinal cord is being squeezed and is causing arm weakness or severe pain.

For cervical spondylosis, the NHS says treatment may include exercises, advice to carry on usual activities, a muscle relaxant if pain has been coming and going for a long time and physiotherapy if symptoms do not improve in a few weeks. Surgery is only considered if a nerve is being pinched by a slipped disc or bone, or if there is a problem with the spinal cord.

Most neck pain settles, but some features need checking. The NHS and Arthritis UK together list the following.

• See a GP if neck pain or stiffness does not go away after a few weeks, painkillers have not worked, you are worried about the pain, or you have other symptoms such as pins and needles or a cold arm.

• Ask for an urgent GP appointment or get help from NHS 111 if you have severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in your arms or legs, pins and needles in an arm as well as pain, or arm pain between your shoulder blades.

• Call 999 if you have new problems walking, loss of bladder or bowel control, sudden lack of co-ordination, a face that droops on one side, cannot lift both arms and keep them there, or have difficulty speaking.

• After an injury, the NHS says to get urgent help for severe pain despite paracetamol or ibuprofen, tingling or pins and needles on one or both sides of the body, problems walking or sitting upright, or an electric-shock feeling in the neck and back.

A stiff neck is also one of the symptoms of meningitis, which the NHS says develop suddenly and can include a high temperature, very cold hands and feet, a severe headache that is getting worse, eye pain when looking at bright lights, confusion, being very sleepy and a rash that does not fade when pressed with a glass. Do not wait for all of these to appear: if neck stiffness comes with a high temperature, a severe headache or any of these symptoms, seek urgent medical help.

Arthritis UK also lists rare causes of neck pain that need urgent attention, including a fracture, infection, a tumour and inflammation, and says to speak to a doctor if you have sudden severe pain after a fall or injury.

The sources used here describe neck pain mainly in adults. In babies and children under 5, the NHS lists meningitis symptoms that can include a stiff body or being floppy or unresponsive, not wanting to feed, a high-pitched or unusual cry and a bulging soft spot on the top of the head, so a child with a stiff neck and fever needs urgent assessment.

If a child has neck pain or stiffness that does not settle or follows an injury, see a GP or call NHS 111, and use the NHS emergency advice above if there are any signs of meningitis or nerve damage.

The NHS suggests that when sleeping you make sure your head is the same height as the rest of your body, have a firm mattress, sit upright and roll your shoulders back gently, and avoid keeping your neck in the same position for a long time, sleeping on your front, or twisting your neck in bed.

Arthritis UK says to check that your desk and computer screen are not too low so that your head is not bent forwards for long periods, to use a chair that supports your back, and to get up regularly to stretch and walk. It says stress can make neck pain worse, and that relaxation can help.

On the NHS, many people can refer themselves to a community musculoskeletal (MSK) service for physiotherapy without seeing a GP, and a GP can arrange tests such as X-rays or scans if needed. The NHS notes that waiting times for NHS physiotherapy can be long and that physiotherapy can also be obtained privately.

Private physiotherapists, osteopaths and chiropractors can treat neck pain. Arthritis UK recommends choosing practitioners who are registered with the relevant professional body, and discussing your symptoms before manipulation, which is not suitable for everyone.