Sensible advice for aches, pains & injuries

When to Worry About Neck Pain…and when not to!

Some tips, checklists, and possible explanations for neck pain that aren’t so scary

by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about
Photo of woman holding her neck, with graphics of red starburst indicating neck pain.

We fear spine pain more than we fear other kinds of pain. Backs and necks seem vulnerable. And yet most spinal pain does not have a serious cause. The bark of neck pain is usually worse than its bite. This article explains how to tell the difference. If you’ve been getting worried, this is a good place to get some reassurance.

Red flags for serious causes of neck pain

Although it’s rare, once in a while neck pain may be a warning sign of cancer, infection, autoimmune disease, or some kind of structural problem like spinal cord injury or a threat to an important blood vessel. Fortunately, most of these ominous situations cause hard-to-miss signs and symptoms other than pain and are likely to be diagnosed correctly and promptly. If you are aware of the “red flags,” you can get checked out when the time is right — but avoid excessive worry before that.

The rule of thumb is that you should start a more thorough medical investigation only when three conditions are met, three general red flags for neck pain:

  1. it’s been bothering you for more than about 6 weeks
  2. it’s severe and/or not improving, or actually getting worse
  3. there is at least one other “red flag” (see below)

And there is one (hopefully obvious) situation where there’s no need to wait several weeks before deciding the situation is serious: if you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves. I didn’t really have to tell you that, did I? Well, I did for legal reasons! 😃

Want more? has a complete guide to neck pain, especially the kind of neck pain that feels like something is stuck — neck cricks. This article is an excerpt.

Several more specific red flags for neck pain: a checklist

Check all that apply. Most people will not be able to check many of these! But the more you can check, the more worthwhile it is to ask your doctor if it’s possible that there’s something more serious going on than just neck pain. Most people who check off an item or two will turn out not to have an ominous health issue. But red flags are reasons to check… not reasons to worry.

Miscellaneous medical causes of neck pain that might mean you can stop worrying about something worse

This section presents quite a comprehensive list of somewhat common medical problems that can cause neck pain (and might, conceivably, be confused with an “ordinary” case of neck pain). I’ll give you a quick idea of what they are and what distinguishes them. If you find anything on this list that seems awfully similar to your case, present the idea to your doctor, and get a referral to a specialist if necessary.

Importantly, none of these are dangerous, although some are certainly quite unpleasant. Although reading about medical problems on the Internet can easily freak us out,3 the point here is to identify possible causes of neck pain that are not so scary. If you can get a positive ID on one of these conditions, then you get to stop worrying about the threat of something worse.

Some skin problems on the neck can cause neck pain, but are usually obvious — most people will identify them as “skin problems on the neck,” not “a neck problem affecting the skin.” Herpes zoster (shingles) [CDC] causes a painful rash, cellulitis [Mayo] is extremely painful but superficial, and a carbuncle[Wikipedia] … well, it’s just a super zit, basically. If you can’t diagnose that one on your own, I can’t help you!

Bornholm disease [NHS] is a crazy viral disease with several other intimidating names.4 It feels like a vice-grip on the chest and lungs, is strongly painful, and sometimes also causes neck pain. If you feel like you can’t breathe, you should look into this. The infection is temporary. It’s an extremely unlikely diagnosis.

Trichinosis [Wikipedia] (or trichinellosis, or trichiniasis) is a parasitic disease caused by eating raw or undercooked pork and wild game. It can be mild or severe or fatal, and digestive disturbance is likely. It can also cause spasming and widespread muscle pain, including the neck. There’s a laundry list of other symptoms.

The temporal artery (in the temple) can become inflamed, with a lot of symptoms, in people with some diseases or infections. Severe headache, fever, scalp tenderness, jaw pain, vision trouble, and ringing in the ears are all possible symptoms, along with neck pain.

Lymphadenopathy. [Merck] The lymph nodes of the neck may bulge and swell in response to disease or infection. Once in a blue moon, someone might mistake these bulgings for muscle knots. More likely, it will be obvious that something else is going on: a variety of other symptoms.

Parsonage-Turner syndrome, [] inflammation of the brachial plexus. For no known reason, sometimes the web of nerves that exit the cervical spine, the brachial plexus, becomes rapidly inflamed. This condition may sometimes occur along with neck pain. Strong pain in the shoulder and arm develops quickly, weakens the limb, and even atrophies the muscles over several months. There is no cure, but most people make a complete recovery.

Thyroiditis, [Wikipedia] inflammation of the thyroid gland in the throat, can be difficult to diagnose, causing a bewildering array of vague symptoms. If your neck pain is accompanied by symptoms like fatigue, weight gain, feeling “fuzzy headed,” depression and constipation, consider checking with your doctor.

Eagle’s syndrome [Medscape] is a rare abnormal elongation of a bizarre little bit of bone at the back of the throat called the styloid process. Even a normal styloid process looks jarring when you first see one: it is so skinny and sharp that it makes one wonder how it can possibly not be stabbing something. Well, it turns out that in some cases it does “stab” you in the neck. This will cause a feeling of a lump in the throat and/or moderate intensity pains throughout the region, possibly including the side of the neck, although pain is more likely to dominate the jaw and throat.5

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Related Reading

What’s new in this article?

Although this content has been around for ages in my neck pain tutorial, I first excerpted it and published as a separate article Jul 2, 2016.

Revised intro, clarified a couple points, added a several links to authoritative sources of information on other conditions that can affect the neck.

Added a couple images, some links. Minor editing.


  1. Thunderclap headaches have many possible causes, several dozen of them (see Devenney et al). Many are frightening and even deadly, but many are also benign, and telling the difference calls for expert help. If you are having sudden, severe headaches, pleae see your doctor. BACK TO TEXT
  2. Symptoms caused by spinal cord trouble are called “myelopathy.” And there are a lot of possible symptoms: it depends on which part of the spinal cord is affected. And many of them can have other causes. And it may worsen slowly and erratically over long periods. You can’t really confirm a myelopathy diagnosis without professional help, so please consult a doctor if you’re suspicious. BACK TO TEXT
  3. [Internet]. Cook G. The Nocebo Effect: How We Worry Ourselves Sick; 2015 May 13 [cited 15 May 13].

    Placebo is belief-powered relief from symptoms, while nocebo is belief-powered symptoms, or “the placebo effect’s malevolent Mr. Hyde.” And: “The Internet has become a powerful…nocebo dosing machine.” Agreed: nocebo is a genuine hazard when writing about medical problems.

  4. AKA epidemic pleurodynia or epidemic myalgia or any of several other interesting and colorful names such as Bamble disease, the Devil’s Grip, and The Grasp of the Phantom! I swear I’m not making these up! BACK TO TEXT
  5. Casale M, Rinaldi V, Quattrocchi C, et al. Atypical chronic head and neck pain: don't forget Eagle's syndrome. Eur Rev Med Pharmacol Sci. 2008;12(2):131–3. PubMed #18575165. BACK TO TEXT