Part of Neck pain
When is neck pain serious? The warning signs and how fast to act
Warning signs, and when to get help
How often is neck pain serious?
Rarely, and that is worth knowing before you read a list of frightening possibilities. The NHS puts it plainly on its neck pain page: neck pain is common, it is not usually a sign of anything serious, and it usually gets better within a few weeks. We are not going to put a percentage on "usually". We do not publish a number we cannot source, and for the neck that figure is not there to be quoted.
What that leaves is more useful than a percentage anyway. The question that actually helps is not what you have. It is how fast you need somebody to look at you, and that comes down to what is sitting alongside the neck pain, not to how much it hurts.
Does a warning sign mean something is wrong?
No, and the framework the lists come from says so about itself. The international framework for red flags in the spine, written for physiotherapists and other clinicians, states that there is "an absence of high-quality evidence for the diagnostic accuracy of most red flags", and describes itself as a way of reasoning through them rather than a test (Finucane and colleagues, 2020). Its own position is that red flags are the best tools a clinician has for raising suspicion of serious spinal disease, and that they work inside a full history and an examination, not on their own.
Read that twice, because every page that hands you a checklist skips it. A single warning sign is common and usually turns out to be nothing. That is true of red flags as a group and it is not true of every line below: each line in the emergency group stands on its own, and being the only thing you have is not a reason to sit on it.
Having none of them does not prove you are fine either. So the list on this page is not a diagnosis you can give yourself. It is a sorting tool: it tells you whether to call an ambulance, go in today, or book an appointment for next week.
It is long, and it is not written to be read end to end. It runs fastest first, so read the emergency group, and if none of it is you, carry on down. Each line says its own route in its own words.
Several of the lines also say to hold off on exercises, or on hands-on treatment to your neck, until somebody has checked you. They mean the exercises in the neck pain program and any neck exercises or stretches you have already been given, along with any massage, mobilization or manipulation you have booked. Stopping those for a day or two while you get seen costs nothing.
That is also why the clinician you see will ask things that seem unrelated to your neck. Your age, any cancer at any time in the past, recent weight change, fever, steroid tablets, falls, how your hands are working, and your bladder and bowels. None of that means anyone suspects something. It is how an examination fills in the context a list on a screen cannot.
When is neck pain an emergency?
These need help now, from an ambulance or from somebody else driving you. If one of them fits you, act on it and come back to the page later. The full wording of each, with the exact action, is in the warning list at the foot of the page.
Any sign of a stroke comes first, even if it has already gone away: a face that droops on one side, an arm you cannot lift or keep up, speech that slurs or sounds muddled, weakness or numbness down one side, sudden blurred or double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or a fall, a sudden severe headache, or legs that give way without you blacking out. Call emergency services straight away. With neck pain these can rarely come from a tear in an artery in the neck.
Two more patterns point at that same torn artery, and they are the reason this page exists in the shape it does. A sudden, severe headache or neck pain that feels new and unlike anything you have had before means calling emergency services. And a new headache or neck pain that does not feel like ordinary neck pain means going to an emergency department straight away, without driving yourself, if either of two things is true: it came on in a single moment, even if it was not severe and even if it has eased since, or nothing you do changes it much and it has not begun to settle after the first day or two. A dissection can start as pain alone, often on one side, with nothing else to find for hours or days, which is why pain that behaves oddly is enough on its own. If you can find a position that eases it, that is the same-day line below instead.
Trauma is the next group. Neck pain straight after a high-energy accident means keeping still and calling emergency services, and if the pain only started later and nobody has checked your neck since, keeping your neck as still as you can and going in straight away. Tell them what kind of accident it was, because that is one of the things that decides whether you need a scan.
Severe neck pain after a knock to the head belongs in the same group, whatever the fall was like. So does new numbness, tingling or weakness in your arms or legs in the first days after an accident. And so does an accident of any size, however minor, where nobody has checked your neck since and your pain is severe, you cannot turn your head halfway toward each shoulder, or the bony middle at the back of your neck is sore when you press it. The whiplash program covers what happens after the neck has been cleared.
The rest of the emergency group is about things that are not really the neck at all. Neck, jaw or arm pain with chest pain, shortness of breath, sweating or feeling sick means calling emergency services. An arm, hand or fingers that turn cold, pale, blue or gray compared with the other side means the blood supply may be blocked. A stiff neck with a fever, a severe headache that is getting worse, bright light hurting your eyes, confusion, or a rash that does not fade under a glass can be meningitis.
That group also covers the spinal cord and the nerves themselves. New problems walking, new trouble with your bladder or bowels, or hands that suddenly become clumsy can mean pressure on the spinal cord in the neck. Neck pain with a fever plus any new arm or leg weakness, numbness or tingling, new trouble walking, or new bladder or bowel trouble can be an infection pressing on the cord or the nerves. And if you have had cancer at any time, the cord compression line in the list applies to you with or without any neck pain at all.
Which neck pain needs a doctor the same day?
Same day means being seen or spoken to today, by your own doctor, an urgent care center or a phone advice line, rather than waiting for a routine slot. It is a real route, not a softer version of the emergency one, and these signs belong on it.
Neck pain with a fever or chills, or feeling generally unwell, goes here, with an emergency department if you feel very unwell. So does new neck pain if you have had cancer at any time or have lost weight without trying, and in that case say so when you ring, because it changes what the doctor looks for. If you are being treated for cancer now, contact your cancer team the same day.
The arm is the other half of this tier, and it comes in four forms. An arm or hand that is getting weaker. Pins and needles in an arm together with neck or arm pain, or an arm that feels heavy or weak, when nobody has looked at it yet. Pain or tingling in both arms at the same time rather than one. Hands that have slowly become clumsy, with trouble doing up buttons or dropping things, or numbness in both hands.
The last two of those can be signs of pressure on the spinal cord, and clumsiness that is getting worse quickly crosses into the emergency group. If your symptoms run down one arm in a band, the cervical radiculopathy program explains why, and neck pain on one side covers the one-sided picture.
Two things matter with that pair, because between them they decide whether this ends as a nuisance or as a permanent loss. Start with the scan. An X-ray of the neck cannot show the spinal cord. The scan that shows whether the cord is being squeezed is an MRI, and the BMJ review of degenerative cervical myelopathy treats that scan and a prompt specialist referral as the standard of care (Davies and colleagues, 2018). Being told an X-ray shows wear and tear is not the same as having been cleared, so if the clumsiness, the numbness or the unsteadiness keeps progressing, go back and say so.
The other thing is what an operation can and cannot do. Decompressing the cord can stop the decline, but the cord itself recovers poorly, and what has already been lost is often permanent. That is why a late diagnosis leaves lasting symptoms behind it. While you wait to be examined, leave the neck exercises and any booked hands-on treatment to your neck alone.
One more pattern belongs in this tier. If you have been told you have carpal tunnel syndrome in both hands, or you have had a carpal tunnel operation that did not help the numbness or the clumsiness, and your legs or your balance are involved as well, ask about your neck. The same review found that pressure on the cord in the neck is frequently diagnosed and treated as carpal tunnel syndrome first, particularly when the label is applied to both hands at once.
Then there are three that do not group with anything else. Severe neck or arm pain that comes on suddenly or is getting worse quickly. An electric shock feeling that runs down your back or into your limbs as your head bends forward. And dizziness, a spinning feeling or feeling sick brought on by turning or tipping your head, which means stopping and being seen today, and calling emergency services if you faint, if it does not settle within a few minutes of sitting still, or if you cannot stand or walk steadily.
One thing this page cannot answer is whether symptoms like these make you unsafe to drive. Dizziness that a head turn sets off, hands that have become clumsy and balance that has changed all bear on it. The rules differ from country to country, so it is a question for the doctor who sees you. Where the warning list sends you in, it already tells you not to drive yourself there.
If you are 50 or over, new frequent headaches with tenderness at your temples or scalp, or jaw pain when you eat or talk, need advice the same day, because inflamed arteries in the head need treating quickly to protect your sight. A vision change with those means calling emergency services.
What can wait a few days?
There is really one pattern here, read at two levels of risk. Pain that is there all the time and does not ease with rest or a change of position, or pain at night that keeps getting worse, means seeing your doctor within a few days. If you have had cancer at any time, or you are losing weight without trying, the same pattern moves up to the same day.
A sore neck that stiffens overnight and eases in the first hour of moving about is ordinary, and it is usually a sleeping position question rather than a warning sign. That is narrower than night pain in general, so read it carefully. Pain that wakes you, that does not ease once you are up and moving, or that is worse each week is the pattern in the paragraph above, and it belongs with your doctor.
When should you worry about neck pain after a fall?
A fall is the one event where the threshold drops, and for some readers it drops a long way. Any neck pain straight after a high-energy fall, such as one from a height or down several stairs, is an emergency, and so is severe neck pain after any knock to the head.
Below that, three groups should be checked the same day after a car accident or a fall, even a minor one, before doing anything with the neck: anyone 65 or older, anyone with low bone density (osteoporosis), and anyone who has taken steroid tablets for a long time. At 65 or older, doctors usually want an X-ray or scan of the neck after an accident. A condition that stiffens the spine, such as ankylosing spondylitis, moves even a trip or a sudden stop in a car into the emergency group, and a neck fused across several levels counts as a stiff spine for this, because a stiff spine can break after a small injury and the break is easy to miss at first.
For everyone else after a minor jolt, four things decide what to do next: pain that is severe, not being able to turn your head about halfway toward each shoulder, tenderness when you press on the bony middle at the back of your neck, and any numbness, tingling or weakness in an arm or leg. Do not test that turn by forcing it. If your neck is stiff or it hurts on the way round, that is the finding and you already have it. If one of the first three fits you and nobody has checked your neck since the accident, keep your neck as still as you can, do not twist or bend it, and go to an emergency department straight away instead of waiting for a routine appointment, without driving yourself.
The limited turn and the sore bony midline are two of the findings that decide whether you need a scan, and that scan is done in hospital. New numbness, tingling or weakness in an arm or leg in the days after an accident is on the emergency list in its own right. Having none of the four does not rule out an injury. If you have none of them and you are still unsure, or the neck does not feel right to you, get it looked at rather than deciding it from this page. If the neck simply locked up and nothing on this page fits, wry neck in adults covers the locked neck and how long it usually takes to free up.
Those four things are not a home test, and this is the part to be careful with. They come from a decision rule emergency doctors apply to someone who is wide awake and otherwise stable, and only after they have checked for the features that mean imaging whatever else is found: being 65 or older, a dangerous mechanism, and pins and needles in the arms or legs (Stiell and colleagues, 2001). Turning the head is the last step of that rule rather than the first, and the doctor only reaches it once the rest is clear. So do not force your neck round to find out whether you can do it. If it is stiff, if it hurts, or if you have to push through anything to get there, stop and treat that as the finding.
The rule was also never meant for someone who was knocked out, who cannot remember the accident, who is confused, who had drink or drugs on board at the time, or who has another injury painful enough to draw attention away from a neck. If any of that is true of you, nothing on this page can speak for your neck and you need somebody to look at it.
When should you go to the emergency room for neck pain?
Go when the warning list at the foot of the page says to, and the practical answer is that the emergency department exists for exactly two things here: the time-critical diagnoses, and the imaging decision after an injury. Everything else is better handled by your own doctor or a physio, who has more time and can follow you up.
Expect the visit to be mostly questions and hands. What kind of accident it was, whether you blacked out, how far you can turn your head, whether the bony midline at the back of the neck is tender, and what your arms and legs are doing. Those answers, with your age and your bone health, are what decides whether you get a scan, which is why the trauma warning line tells you to say what the accident was. Australia's healthdirect puts the ambulance threshold for the neck in three phrases: sudden severe neck pain, neck pain after a traumatic accident, and neck pain with chest pain, shortness of breath or sweating.
The list on this page splits the first of those by how the pain compares. A sudden, severe headache or neck pain that feels new and unlike anything you have had before means calling emergency services straight away, and a sudden severe flare in a neck you already know is the same-day line. If you cannot tell which of those you have, treat it as the more urgent one.
What the department is unlikely to give you is an explanation for ordinary neck pain. A normal examination and a normal scan are a good result and a common one, and they are not the same thing as nothing being wrong with how your neck is working. That part is the neck pain program, once you have been cleared.
What changes if you have had an operation on your neck?
Your surgeon's or surgical team's plan comes first and overrides everything on this page, and nothing here replaces the follow-up appointment they have booked for you. Do not start or restart neck exercises, and do not have hands-on treatment to your neck, until that team says it is time.
The airway comes first, and it is why this section exists. In the days and the weeks after an operation on the front of your neck, new swelling in your neck, trouble breathing, breathing that has turned noisy, a feeling that you can only breathe while sitting up, or trouble swallowing that is getting worse, with or without a fever, means calling emergency services straight away. Not phoning the ward and waiting for somebody to call you back, and not being driven in by a relative. A narrowing airway can close in minutes, the crew can keep you breathing on the way in, and sitting upright while you wait is better than lying down.
The window is longer than people expect, which is why the line in the list does not stop at the end of the first week: bleeding or swelling in front of the spine can narrow the airway in the first hours and first day, swelling of the throat tissues can do it in the first three days, and an infection behind the throat can do it after that (Debkowska and colleagues, 2019).
Next, anything new in your arms or legs, and this one applies whether the operation was done from the front of the neck or from the back. New weakness or numbness, weakness that is worse hour by hour, new trouble walking, or new trouble passing urine or controlling your bladder or bowels is an emergency rather than a phase of recovery, because blood or swelling can collect around the spinal cord after either approach and press on it.
Then the wound, which has no end date on it. Red, hot, more swollen or more painful, opened, or leaking, or a fever and feeling generally unwell, means contacting the team that operated the same day, months afterwards as readily as in the first weeks, because an infection in an operated spine can reach the bone and any metalwork. Redness can be harder to see on brown or black skin, so the heat, the swelling and the pain count as much as the color does. An injection into your neck or spine in the last three months belongs here too, and so does neck pain or a headache that is new or much worse, with no fever and nothing to see at the wound. Clear watery fluid leaking from the wound, or a headache that is much worse when you sit or stand and eases when you lie flat, is the same phone call today: that pattern can mean fluid leaking from around the spinal cord.
Swallowing and your voice are their own group after an operation at the front of the neck. Swallowing that is no worse but still stops you eating and drinking normally, food catching in your throat, coughing or choking on drinks, or a voice still hoarse or weak after a few weeks all go back to the team that operated rather than to a physio. They are the people who know what this approach does on its way to healing and what it does not, and choking on drinks gets attention quickly because of what it can do to the lungs.
A returning symptom is the last of them. If you have had an operation for a squeezed nerve or for pressure on the spinal cord, and the tingling, numbness or arm pain has come back after settling, or new weakness has appeared in a hand or arm, get advice from the team that operated the same day. What a returning symptom means after that operation depends on what was done and on what your scan showed, so it is their question rather than a physio's. New trouble walking, new bladder or bowel trouble, or hands that have suddenly become clumsy is the emergency line instead. A new mechanical symptom long afterwards belongs to them too, such as neck pain that has changed with movement or swallowing that alters again months or years later.
Pregnancy, children, and the other groups that change the answer
If you are pregnant or had a baby in the last few weeks, a severe headache that simple painkillers do not shift, vision problems such as blurring or flashing lights, pain just below your ribs, vomiting, sudden swelling of your face, hands or feet, or feeling very unwell means contacting your maternity unit straight away. Those can be signs of pre-eclampsia, which can develop in the days or weeks after the birth. The full line, including what to do about a headache after an epidural and when to call emergency services, is in the list below.
This page is written for adults. A child or teenager with neck pain needs to be seen by a doctor or physio rather than treated at home.
If you have rheumatoid arthritis, new neck pain or a new headache at the back of your head that keeps coming back needs its own route, because the top of the neck can be involved in that condition. The line in the list below gives three levels, and the most urgent of them is unsteadiness or legs that feel stiff, heavy or weak. The rheumatoid arthritis page has the wider picture.
The same applies if you have Down syndrome, or you have been told the top of your neck is unstable or your spinal canal is narrowed: get the neck looked at before you do anything with it. A neck that has been fused across several levels behaves like a stiff spine too, so after a knock or a fall treat yourself the way the stiff spine group above is treated and get seen rather than waiting to see how it goes.
What if your neck pain is just not getting better?
That is a routine reason to book rather than a warning sign, and the usual sources disagree on the timing because they are answering two different questions. The NHS says neck pain usually gets better within a few weeks and to see a GP if it has not gone by then, if painkillers have not helped, or if other symptoms have appeared. Australia's healthdirect gives 7 to 10 days for a neck that has locked up. The first is about ordinary neck pain over its whole course; the second is about one short, specific episode. Neither is a deadline.
So the practical version: a neck that is slowly improving, moves more each week and has none of the signs above does not need a timer on it. A neck that has stopped improving, that stops you working or sleeping, or that keeps coming back is worth an assessment whatever week it is.
One distinction before you book, though. Not getting better is not the same as slowly getting worse. A stubborn neck that is otherwise stable is a routine appointment, while pain, numbness, hand clumsiness or balance that is a little worse every month belongs on the same day route in the section above, because that is the pattern nobody should be waiting out. The neck pain program is where the exercise side of that starts, and can neck pain cause headaches covers the combination that brings most people to this page in the first place.
One sign in the list below appears twice, at two different speeds. Pain that is there all the time and does not ease with rest or changing position, or pain at night that keeps getting worse, is a same-day matter if you have had cancer at any time or have lost weight without trying, and otherwise needs your doctor within a few days. If you cannot tell which of those you have, treat it as the more urgent one.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away. With neck pain, these can rarely come from a tear in an artery in the neck.
- Emergency: a sudden, severe headache or neck pain that feels new and unlike anything you have had before. Call emergency services straight away.
- Emergency: a new headache, or new pain on one side of your face, jaw or neck, with a drooping eyelid or a smaller pupil on the same side, or with a new pulsing or whooshing sound in one ear that keeps time with your heartbeat. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be a tear in an artery in the neck (cervical artery dissection), which can lead to a stroke.
- Emergency: a new headache or neck pain, or both, that does not feel like ordinary neck pain. If this is your first bout, judge it by how it behaves rather than by how it compares. Either of the next two is enough on its own. One, it came on suddenly, in a single moment, even if it is not severe and even if it has eased since. Sudden onset counts on its own. Two, nothing you do changes it much: no position or rest makes a real difference, and after the first day or two it has not started to settle. It counts even if you have none of the other emergency signs above, and it matters more if it started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated. Go to an emergency department straight away, or call emergency services if you cannot get there safely, and do not drive yourself. Do not start these exercises, and do not have any hands-on treatment to your neck, until your neck has been checked. A tear in an artery in the neck can start as pain alone, often on one side, with nothing else to find. If it came on gradually rather than in a single moment, and you can find a position that eases it, follow the same day warning sign for this below instead. Pain that started in one moment stays with this emergency line even if a position now eases it.
- Emergency: a stiff neck with a fever, a severe headache that is getting worse, pain when you look at bright lights, confusion, or a rash that does not fade when you press a glass on it. Call emergency services. These can be signs of meningitis.
- Emergency: neck pain straight after a high-energy accident, such as a crash at high speed, a car that rolled over, being thrown from a vehicle, being hit by a vehicle while walking or cycling, a motorbike or quad bike accident, a horse riding accident, a diving injury, or a fall from a height or down several stairs. Keep still and call emergency services. If the neck pain only starts later and nobody has checked your neck since, keep your neck as still as you can, do not twist or bend it, and call emergency services or go to an emergency department straight away. Do not drive yourself, and tell them what kind of accident it was, because that is one of the things that decides whether you need a scan.
- Emergency: severe neck pain after a knock to the head, whatever the fall or the knock was like. Keep still and call emergency services, and do not let anyone move you until someone trained has checked your neck. If the neck pain only starts later and nobody has checked your neck since, go to an emergency department straight away, and do not drive yourself.
- Emergency: nobody has checked your neck since the accident, and your neck pain is severe, you cannot turn your head halfway toward each shoulder, or the bony middle of the back of your neck is sore when pressed. Keep your neck as still as you can, do not twist or bend it, and go to an emergency department straight away rather than waiting for a routine doctor's appointment. Do not drive yourself, and call emergency services if you cannot get there without moving your neck. Not being able to turn your head halfway, and soreness over the bony middle of the back of your neck, are two of the findings that decide whether you need a scan, and that scan is done in hospital. Do not start these exercises until your neck has been checked.
- Emergency: in the first days after the accident, numbness, tingling, pins and needles or weakness in your arms or legs, or a sudden electric shock feeling in your neck and back that runs into your arms or legs. If it starts straight after the accident, keep still and call emergency services. If it starts later, call emergency services or go to an emergency department straight away, and do not drive yourself.
- Emergency: new neck or back pain after a fall, a knock or a jolt, even a minor one such as a trip or a sudden stop in a car, if you have a condition that stiffens the spine, such as ankylosing spondylitis. Call emergency services or go to an emergency department straight away, do not drive yourself, and tell the staff about your spine condition, so they keep your neck and back in their usual position. A stiff spine can break after a small injury, and the break is easy to miss at first. If the pain started straight after the injury, or you also have numbness, tingling or weakness in your arms or legs, keep still and call emergency services.
- Emergency: neck, jaw or arm pain that comes with chest pain, shortness of breath, sweating or feeling sick. Call emergency services.
- Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- Emergency: new problems walking, for example your legs feel stiff, heavy or weak or you have become unsteady on your feet, new trouble controlling your bladder or bowels, or hands that suddenly become clumsy, for example you can no longer do up buttons. Call emergency services straight away. These can be signs of pressure on the spinal cord in the neck.
- Emergency: new trouble passing urine, a stream that is hard to start or has become weak, or a feeling that your bladder never empties, together with neck pain, new numbness or tingling in your arms or legs, or new trouble walking. Call emergency services straight away. Trouble emptying the bladder can be the first bladder sign of pressure on the spinal cord in the neck, and it counts as urgently as leaking does (Davies and colleagues, 2018).
- Emergency: in the days or the weeks after an operation on the front of your neck, new swelling in your neck, trouble breathing, breathing that has turned noisy or whistling, a feeling that you can only breathe while sitting up, or trouble swallowing that is getting worse, with or without a fever. Call emergency services straight away. Do not phone the ward or your surgeon first and wait for someone to call back, do not drive and do not let anyone drive you in, and sit upright rather than lying down while you wait. Bleeding or swelling in front of the spine can narrow the airway in the first hours and the first day after this operation, swelling of the throat tissues can do it in the first three days, and an infection behind the throat can do it after that, which is why this line does not stop at the end of the first week (Debkowska and colleagues, 2019).
- Emergency: in the days or the weeks after any operation on your neck, whether it was done from the front or from the back, new weakness or numbness in your arms or legs, weakness that is getting worse hour by hour, new trouble walking, or new trouble passing urine or controlling your bladder or bowels. Call emergency services straight away rather than waiting to see whether it settles as part of recovery. Blood or swelling can collect around the spinal cord after an operation on the neck and press on it, and that is treated as an emergency at any stage of the recovery.
- Emergency: neck pain with a fever, or you feel hot, shivery or very unwell, and you also have new weakness, numbness or tingling in one or both arms or legs, new trouble walking, or new trouble with your bladder or bowels. Call emergency services or go to an emergency department straight away. This can be an infection pressing on the spinal cord or nerves in the neck (spinal epidural abscess), which needs emergency treatment.
- Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or you have new or worsening pain spreading down an arm or leg, weakness, numbness, pins and needles or a loss of feeling in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Those symptoms count on their own, with or without back or neck pain. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through, and do not drive yourself. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
Get help now, day or night
- You are pregnant or had a baby in the last few weeks and have a severe headache that does not go away with simple painkillers, problems with your vision such as blurring or flashing lights, pain just below your ribs, vomiting, heartburn that does not go away with heartburn medicines, sudden swelling of your face, hands or feet, or you feel very unwell. Contact your maternity unit straight away, or get urgent medical help if you cannot reach them. These can be signs of pre-eclampsia, which can develop in the days or weeks after the birth and needs checking immediately. The same applies to a headache after an epidural or spinal anesthetic that gets worse when you sit or stand up and eases when you lie down. Call emergency services if you have a fit (seizure) or a headache that came on suddenly and is very severe. Call emergency services too if you have a headache with a stiff neck and either a high temperature or bright light hurting your eyes, as this can be meningitis.
- Same day: you have rheumatoid arthritis and get new neck pain, or a new headache at the back of your head that keeps coming back. If it comes with tingling or numbness in your hands or arms, get medical advice the same day. If you also feel unsteady on your feet or your legs feel stiff, heavy or weak, call emergency services straight away. Without any of those, tell your doctor or rheumatology team within a few days, and leave out any neck exercises until you have been checked.
Get help today
- Same day: a new headache or neck pain, or both, that does not feel like ordinary neck pain, that came on gradually rather than in a single moment, that started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated, but that does ease when you change position or rest. Get checked the same day before you start these exercises or have any hands-on treatment to your neck. If nothing you do changes it much any more, or it has not started to settle after a day or two, or it did come on in a single moment, follow the emergency warning sign for this above.
- Same day: you have had an operation on your neck for a squeezed nerve or for pressure on the spinal cord, and the tingling, numbness or arm pain has come back after settling, or new weakness has appeared in a hand or arm. Get advice from the team that operated the same day. What a returning symptom means after that operation depends on what was done and on what your scan showed, so it is their question rather than a physio's. If you also have new trouble walking, new trouble controlling your bladder or bowels, or hands that have suddenly become clumsy, use the emergency line above instead and call emergency services straight away.
- Same day: since your neck operation, the wound has become red, hot, more swollen or more painful, has opened, or is leaking fluid or pus, or you have a fever, chills or feel generally unwell. Redness can be harder to see on brown or black skin. The same call applies if you have had an injection into your neck or spine in the last three months, and it applies to neck pain or a headache that is new or much worse, even without a fever. That holds months after the operation as well as in the first weeks. Contact the team that operated the same day, and go to an emergency department if you feel very unwell. An infection in an operated spine can involve the bone and any metalwork, and it needs treating early. If swelling at the front of your neck comes with trouble breathing or trouble swallowing that is getting worse, use the emergency line above instead and call emergency services.
- Same day: clear, watery fluid leaking from your neck wound after an operation, a dressing that keeps soaking through, or a headache that is much worse when you sit or stand and eases when you lie flat. Contact the team that operated the same day. This can mean fluid is leaking from around the spinal cord, which is theirs to sort out rather than a physio's. Call emergency services if you also get a fever, a stiff neck, bright light hurting your eyes or confusion.
- Same day: after an operation on the front of your neck, swallowing that is no worse than it was but still stops you eating or drinking normally, food catching in your throat, coughing or choking when you drink, or a voice that is still hoarse or weak after a few weeks. Contact the team that operated the same day. They are the ones who know what is an ordinary part of healing after an operation at the front of the neck and what needs looking at, and choking on drinks is dealt with quickly because of what it can do to your lungs.
- Same day: you have been told you have carpal tunnel syndrome in both hands, or you have had a carpal tunnel operation and the numbness or clumsiness has not improved, and you also have neck pain or stiffness, numbness or pins and needles in your legs or feet, or you have become less steady on your feet. Get medical advice the same day and ask about your neck. Pressure on the spinal cord in the neck is often labeled as carpal tunnel syndrome first, particularly when it is diagnosed in both hands at once (Davies and colleagues, 2018).
- Same day: dizziness, a spinning feeling or feeling sick that comes on when you turn or tip your head, without any of the emergency signs above. Stop the exercises and get medical advice the same day. If you faint, it does not settle within a few minutes of sitting still, or you cannot stand or walk steadily, call emergency services.
- Same day: hands that have slowly become clumsy, for example trouble doing up buttons or dropping things, or numbness in both hands. Get medical advice the same day. These can be signs of pressure on the spinal cord in the neck (cervical myelopathy). If the clumsiness or numbness gets worse quickly, call emergency services straight away.
- Same day: pain or tingling in both arms at the same time, rather than in one. Get medical advice the same day. This can also be a sign of pressure on the spinal cord in the neck.
- Same day: an electric shock feeling runs down your back or into your arms or legs as your head bends forward. Stop and get medical advice the same day.
- Same day: pins and needles in an arm together with neck or arm pain, or an arm that feels heavy or weak, and nobody has checked it yet. Get medical advice the same day.
- Same day: an arm or hand that is getting weaker. Get medical advice the same day.
- Same day: severe neck or arm pain that comes on suddenly or is getting worse quickly, without any of the emergency signs above. Get medical advice the same day.
- Same day: neck pain with a fever or chills, or you feel generally unwell. Get medical advice the same day, and go to an emergency department if you feel very unwell.
- Same day: new neck pain that is severe or getting worse, if you inject drugs or take medicine that weakens your immune system. Get medical advice the same day and say which of those applies. An infection in the spine does not always cause a fever, and a normal temperature is not a reason to be reassured.
- Same day: new, frequent headaches with pain or tenderness at your temples or on your scalp, or jaw pain when you eat or talk, or, if you are 50 or over, a temple or scalp that has become tender to touch, for example when you brush your hair or rest your head on a pillow. Get medical advice the same day. These can be signs of inflamed arteries in the head (temporal arteritis, also called giant cell arteritis). If your vision changes, call emergency services.
- Same day: new neck pain and you have had cancer, now or in the past, or you have lost weight without trying. Get medical advice the same day and mention it. If you are being treated for cancer now, contact your cancer team the same day.
- Same day: neck pain after a car accident or a fall, even a minor one, if you are 65 or older, have low bone density (osteoporosis) or have taken steroid tablets for a long time. Get your neck checked by a doctor the same day, for example at an emergency department, before you start these exercises. At 65 or older, doctors usually want an X-ray or scan of the neck after an accident.
- Same day: pain that is there all the time and does not ease with rest or changing position, or pain at night that keeps getting worse. If you have had cancer, now or in the past, or you have lost weight without trying, get medical advice the same day.
Book an appointment
- Within a few days: pain that is there all the time and does not ease with rest or changing position, or pain at night that keeps getting worse. See your doctor within a few days.
Common questions
When should you worry about neck pain?
When it comes with something else, and the something else decides how fast you act rather than what you have. Three speeds cover almost everything. Right now, with an ambulance or someone else driving: any sign of a stroke, a sudden severe headache or neck pain unlike anything you have had before, neck pain straight after a high-energy accident or a knock to the head, a stiff neck with a fever, neck or jaw pain with chest pain, an arm that turns cold or pale, new problems walking, and new trouble with your bladder or bowels. Add one more to that list: any accident, however minor, where nobody has checked your neck since and the pain is severe, you cannot turn your head halfway toward each shoulder, or the bony midline at the back of your neck is sore when pressed. Those three are findings a doctor works with rather than a test for clearing yourself, and having none of them does not mean the neck is fine. Today: neck pain with a fever on its own, new neck pain when you have had cancer or have lost weight without trying, an arm or hand that is getting weaker, pins and needles in an arm that nobody has looked at, and dizziness brought on by turning your head. Within a few days: pain that is there all the time, or pain at night that keeps getting worse. Neck pain on its own, that moves and changes with position and is slowly settling, is the ordinary kind.
Can severe neck pain be cancer?
It can, rarely, and the question deserves an answer rather than a dodge. What raises the concern is not how severe the pain is but the company it keeps: a history of cancer at any time, weight you have lost without trying, pain that is there all the time and does not ease with rest or changing position, or pain at night that keeps getting worse. New neck pain with a cancer history, now or in the past, or with unexplained weight loss, means getting medical advice the same day and mentioning it, and if you are being treated for cancer now, contact your cancer team the same day. One pattern is an emergency rather than a same-day matter. If you have had cancer and your back or neck pain feels like a tight band around your body, or you have new or worsening pain spreading down an arm or leg, weakness, numbness, pins and needles or a loss of feeling in your arms or legs, trouble walking, or trouble controlling your bladder or bowels, call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through, and do not drive yourself. Those symptoms count on their own, with or without pain.
How long does severe neck pain last?
No source we could verify gives a length for severe neck pain, and we are not going to invent one. What is documented is the ordinary course: the NHS says neck pain usually gets better within a few weeks, and healthdirect Australia says a locked neck usually clears within 7 to 10 days. Severity on its own is not what decides the timing of getting seen. Severe neck or arm pain that comes on suddenly, or that is getting worse quickly, needs medical advice the same day whatever week you are in. And a new headache or neck pain that does not feel like ordinary neck pain, that came on in a single moment, or that nothing you do changes and that has not started to settle after the first day or two, means going to an emergency department straight away without driving yourself.
Is neck pain serious in children?
This page is written for adults. A child or teenager with neck pain needs to be seen by a doctor or physio rather than treated at home, because the causes are different and some of them need finding quickly. That is true even when the neck pain looks like the ordinary stiff kind, and it is the reason we give a referral line here rather than a list of signs for a parent to work through. Take a child straight to emergency care for the same things that would take an adult there: a stiff neck with a fever, a rash that does not fade when you press a glass on it, bright light hurting their eyes, drowsiness or confusion, neck pain after a fall or a blow to the head, or new weakness, numbness or trouble walking.
References
- Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic and Sports Physical Therapy. 2020;50(7):350-372. https://doi.org/10.2519/jospt.2020.9971
- Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. https://doi.org/10.1001/jama.286.15.1841
- NHS. Neck pain. Page last reviewed 27 April 2023. https://www.nhs.uk/symptoms/neck-pain-and-stiff-neck/
- healthdirect. Neck pain. https://www.healthdirect.gov.au/neck-pain
- healthdirect Australia. Torticollis (wry neck). Last reviewed March 2026. https://www.healthdirect.gov.au/torticollis
- Doukhi D, Debette S, Mawet J. Headaches attributed to cranial and cervical artery dissections. The Journal of Headache and Pain. 2025;26(1):28. https://doi.org/10.1186/s10194-025-01958-9
- Rushton A, Carlesso LC, Flynn T, et al. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic and Sports Physical Therapy. 2023;53(1):7-22. https://doi.org/10.2519/jospt.2022.11147
- Rushton A, Carlesso LC, Flynn T, et al. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to orthopaedic manual therapy (OMT) intervention: International IFOMPT Cervical Framework. IFOMPT. 2020, with 2023 addendum. https://www.ifompt.org/wp-content/uploads/2026/09/IFOMPT-cervical-framework-final-2020-Add-2023.pdf
- Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018;360:k186. https://doi.org/10.1136/bmj.k186
- Darouiche RO. Spinal epidural abscess. New England Journal of Medicine. 2006;355(19):2012-2020. https://doi.org/10.1056/NEJMra055111
- Debkowska MP, Butterworth JF, Moore JE, Kang S, Appelbaum EN, Zuelzer WA. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. Journal of Spine Surgery. 2019;5(1):142-154. https://doi.org/10.21037/jss.2019.03.01
- National Institute for Health and Care Excellence (NICE). Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. Published September 2023. https://www.nice.org.uk/guidance/ng234
- National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management. Clinical guideline CG150. 2012, last updated 2025. https://www.nice.org.uk/guidance/cg150
- National Institute for Health and Care Excellence (NICE). Head injury: assessment and early management. NICE guideline NG232. Published 18 May 2023. https://www.nice.org.uk/guidance/ng232
- Sport and Recreation Alliance and UK Government. UK concussion guidelines for non-elite (grassroots) sport. Published 2023, updated November 2024. https://sportandrecreation.org.uk/campaigns-and-policy/concussion/concussion-guidelines-for-grassroots-sport-html-version
- NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/
- NHS. Meningitis. https://www.nhs.uk/conditions/meningitis/
- NHS. Temporal arteritis. https://www.nhs.uk/conditions/temporal-arteritis/
- NHS. Cervical spondylosis. https://www.nhs.uk/conditions/cervical-spondylosis/
- NHS. Pre-eclampsia. https://www.nhs.uk/conditions/pre-eclampsia/
Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.