Headache with a stiff neck: causes and when to get urgent help

A headache with a stiff or sore neck is common and usually comes from tension, an awkward sleeping position, posture or a migraine. The NHS says most neck pain lasts only a few weeks and that most headaches are not a sign of anything more serious.

The reason the pairing gets special attention is that two uncommon emergencies, meningitis and a bleed around the brain, can cause it. What separates a sore neck from a dangerous one is rarely the neck alone. It is the company it keeps: fever, a rash, a very sudden and severe headache, vomiting, confusion or discomfort in bright light.

If you are unsure and you are unwell, the NHS advises getting medical help immediately rather than waiting to see how things develop.

The NHS headache page says to call 999 or go to A&E if you or a child has a headache and any of the following. Do not drive yourself, and bring any medicines you take.

• A very high temperature, a stiff neck, or bright lights are bothering you.

• A rash that does not fade when a glass is rolled over it.

• The headache started suddenly and is extremely painful.

• Numbness or weakness in the body or face, or difficulty speaking, balancing, walking or remembering things.

• Drowsiness or confusion, a seizure, or loss of vision.

• A head injury within the last 3 months.

Meningitis is an infection of the protective layers that cover the brain and spinal cord. The NHS says it can be very serious and even life-threatening if not treated quickly, and that its symptoms develop suddenly. They include a high temperature, very cold hands and feet, a stiff neck, joint and muscle pain, a severe headache that is getting worse, eye pain when looking at bright lights, seizures, vomiting, confusion, being very sleepy or difficult to wake, and a rash that does not fade when pressed with a glass.

The NHS also warns that some early symptoms can be similar to flu, a stomach bug or a hangover, that not everyone gets a rash, and that a person with meningitis might not have every symptom. Its advice is to trust your instincts and get immediate medical help if you or your child are unwell and you think something is seriously wrong.

For an adult or child aged 5 or over the NHS lists, among reasons to call 999 or go to A&E, a very painful headache, being confused or having slurred speech, and a stiff neck with being unable to look at bright lights.

The NHS describes a subarachnoid haemorrhage as a rare type of stroke that causes bleeding on the brain and is a life-threatening emergency. Its main symptoms include an extremely painful headache that starts suddenly and does not go away, neck pain or a stiff neck, feeling and being sick, being very sensitive to light, seizures, fainting, feeling sleepy or confused, and drooping on one side of the face, slurred speech or weakness on one side of the body.

The NHS adds that it can happen at any time but may be more likely when coughing, going to the toilet, lifting something heavy or having sex. It advises calling 999 for a sudden, extremely painful headache that does not go away.

The NHS neck pain page lists the most common causes of neck pain as the neck becoming locked in an awkward position while sleeping, bad posture such as sitting at a desk for a long time, a pinched nerve, and an injury such as whiplash. It advises seeing a GP if neck pain or stiffness does not go away after a few weeks, painkillers have not worked, you are worried, or you have other symptoms such as pins and needles or a cold arm.

On the headache side, the NHS lists common causes including a cold or flu, stress, too much alcohol, bad posture, eyesight problems, not eating regularly, dehydration, taking too many painkillers and hormonal changes. It says a stiff neck can also occur at the start of a migraine attack, alongside tiredness, yawning, mood changes and food cravings.

The NHS meningitis list describes a stiff neck that comes together with illness: a high temperature, a headache that is getting worse, eye pain in bright light, drowsiness or confusion. A neck that is simply sore after a night in an awkward position does not come with those features, but this is not a test, and anyone in doubt should seek help.

Between self-care and 999 there is a middle category. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if a headache comes with vision or eye problems, if it is triggered or made worse by coughing, sneezing, bending down or exercising, if you are being sick, or if you have jaw pain when eating or a sore or tender scalp. It adds that you should see a GP if a headache is not getting better with self-care, is getting worse or happens regularly.

For home care of an ordinary headache the NHS suggests drinking plenty of water, resting, trying to relax, taking paracetamol or ibuprofen, avoiding skipping meals, and avoiding long periods of eye strain. If you are taking painkillers, check the packet and speak to a pharmacist if you are unsure what is suitable for you.