Common Causes of Axial Neck Pain

Axial neck pain refers to pain over and/or around the cervical spine or neck. The source of axial neck pain originates from the neck muscles/ligaments/joints. This is in contrast to radicular sources of neck pain, like cervical radiculopathy or cervical spondylotic myelopathy, which involve nerve or spinal cord compression. With axial neck pain, patients may note headaches or pain in their shoulders, in addition to neck soreness and/or stiffness.

When confirming the diagnosis, your doctor will rule out "referred" sources of neck pain, like a tumor or an infection, as these can mimic axial neck pain. He will also do a neurological examination to rule out nerve involvement or radiculopathy.

Woman with neck pain
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A number of medical conditions cause axial neck pain. Here are a few examples:

  • Cervical Strain: After an injury to the neck, an individual may develop a spasm of the neck and upper back muscles. Patients commonly point to their trapezius muscle, a large superficial muscle that extends from the back of the head down to the mid back and laterally to the shoulder blade. Spontaneous improvement is common.
  • Cervical Discogenic Pain: This is the most common cause of neck pain. This disorder refers to "derangement of the architecture" of one of the cervical discs. There may or may not be associated inflammation. Pain is worse when the neck is held in one position for too long. There may also be a limited range of motion of the neck. A patient may have radicular symptoms (e.g. numbness or tingling in the arms), but axial are usually more notable.
  • Cervical Facet Syndrome: This is also a common source of neck pain and refers to a disorder of the facet joint or zygapophyseal joint. The facet joints are small joints located between and behind each vertebra. They help prevent excessive rotation and flexion of the spine. If you suffer from cervical facet syndrome, you will likely have pain over or just to the side of the vertebrae in your neck. Like cervical discogenic pain, you may have radicular symptoms as well, but again, axial are more prominent.
  • Whiplash: Whiplash commonly occurs during a car accident when there is a sudden and intense accelerating and/or decelerating motion of the neck causing it to flex and/or extend rapidly. Whiplash causes a strain or sprain of the neck muscles and/or ligaments, but it can also affect the vertebrae (7 bones in the neck), discs (cushion between the vertebrae), or nerves in the neck. Symptoms such as neck pain and a whiplash headache may occur right after the injury or days later.

A Word From Verywell

Axial neck disorders cause neck muscle spasm, irritability, and pain. Patients usually seek medical attention when the pain is persistent and begins interfering with their daily activities.

Fortunately, axial neck pain can be treated with simple, conservative measures, like a combination of home exercises and over-the-counter medications.

Please note that treatment for axial neck pain is different from that of radicular neck pain.

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Article Sources
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  • NIH NINDS. Whiplash Information Page.

  • Anderson BC, Isaac Z, Devine J. Treatment of Neck Pain. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014. 
  • Patient information: Whiplash (The Basics). In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014.