Neck pain is a common medical complaint with a prevalence as high as 87%.  Studies have noted, “Prevalence is generally higher in women, higher in high-income countries compared with low- and middle-income countries and higher in urban areas compared with rural areas. Many environmental and personal factors influence the onset and course of neck pain. Most studies indicate a higher incidence of neck pain among women and an increased risk of developing neck pain until the 35-49-year age group, after which the risk begins to decline.” – US National Library of Medicine National Institutes of Health

Neck pain may be caused by:

Bone Malalignments

 These are known as osteopathic somatic dysfunctions (SD). These are minor changes in the interrelationship of the cervical and thoracic vertebrae causing local monitoring nerves to send out protective nerve signals.  These protective signals cause pain and muscle tightness that may be referred to as a stiff neck.  This commonly occurs without any appreciable trauma, “I woke up with it”.  In more complicated situations SD can happen with trauma.  Not visible on MRI.  Responsive to OMT/PT.  Sometimes NSAID’s or neurological stabilizing agents can aid in recovery.

Poor posture

Forward head and shoulder carriage can cause stress on neck musculature causing pain.  This can be treated with physical therapies to improve strength and flexibility.

Migraine 

Neck pain is a common feature of migrainous events.  It is known to precede or coincide with migraine, and may persist between events.  Neck pain may also be the first symptom that a migraine patient may exhibit.  This pain may present as tension, pressure or clear pain.  This is sometimes referred to as tension headache however it is commonly responsive to migraine treatment.  This neck pain is caused by over activity of areas in the brain stem that irritate nerves serving the neck.  Not visible on MRI.  Responsive to migraine treatment.

Sprains/Strains 

These are trauma based injury to neck muscle, tendons and ligaments.  Sometime called whiplash.  When clearly diagnosable sprains/strains occur they are commonly accompanied by bruising.

Stretch Stimulus

Lower grade stretch stimulus  to cervical muscle, tendons and ligaments can set up a nerve over-stimulation condition.  Interestingly, these structures are heavily innervated and feed nerve signals into the brain stem sometimes causing migrainous symptoms.  This phenomena could reasonably be categorized as post traumatic migraine and is sometimes diagnosed as Traumatic Brain Injury.  This is typically responsive to migraine treatment.

Cervical Disc Herniations

 Sometimes called a slipped disc or pinched nerve.  A cervical disc is herniated when its  inner core, the jelly-like nucleus pulposus, leaks out through a tear in the disc’s fibrous outer layer. This commonly results from an injury or aging.  A herniated disc may press against a cervical nerve, or the inflammatory chemicals of the nucleus pulposus may come come into contact with a nerve causing irritation.  Either physical contact or the chemical irritation can stimulate the nerves causing pain, weakness or sensory change (numbness/ tingling).  Cervical herniations  most commonly happens to lower cervical nerve roots, about C5-C7, resulting in arm symptoms.  Rarely, herniations can occur in the upper C-spine, C2-C4 causing pain in the upper neck and back of the head.  This looks like migraine neck pain but is identifiable by MRI.  Neck pain is not the primary symptom of clear disc herniations.

Cervical Arthritis

 This may be degenerative or autoimmune and is diagnosed with X-rays and blood work.  Degenerative facet arthropathy is responsive to spinal injections called medial branch blocks and radiofrequency ablation.  Autoimmune arthropathy can be rheumatoid arthritis or ankylosing spondylitis and is treated by rheumatology.

Infection

 Meningitis can cause neck stiffness and pain.  Patients usually have fever and feel sick.  Diagnosis is usually by physical exam and blood work.

Cancers

 Primary or metastatic tumors can invade structures in the neck and cause pain.  These are visible with radiology studies.

Creekside Physical Medicine
and The Migraine Center

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