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, or joints. It often causes headaches or pain in the shoulders, in addition to neck soreness and stiffness.

This is in contrast to radicular sources of neck pain, like cervical radiculopathy or cervical myelopathy, which involve spinal nerve compression or spinal cord compression.

Woman with neck pain
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Damage or injury to the soft tissue surrounding the cervical spine can lead to axial neck pain. A number of medical conditions can cause it.

Here are a few examples:

  • Cervical Strain: An injury to the neck ligaments or muscles can lead to spasms of the neck and upper back muscles. The 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, is often affected. Spontaneous improvement is common.
  • Cervical Discogenic Pain: This is the most common cause of neck pain. This disorder refers to degeneration of the cervical discs, sometimes with 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. This can also cause radicular symptoms (e.g. numbness or tingling in the arms), but axial symptoms 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 have cervical facet syndrome, you will likely have pain over or just to the side of the vertebrae in your neck. You may have radicular symptoms as well, but axial symptoms are more prominent.
  • Whiplash: Whiplash commonly occurs during car accidents. It is an injury that can happen when there is a sudden and intense accelerating or decelerating motion of the neck causing it to flex or extend rapidly. Whiplash causes a strain or sprain of the neck muscles and ligaments. 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 spasms, irritability, and pain. Some people may try to ignore the symptoms, but it can cause persistent pain that interferes with daily activities. Make sure you see a healthcare professional if you have neck pain. A diagnosis is important, and treatment can help you feel better.

Treatment for axial neck pain is different from treatment for radicular neck pain. Fortunately, axial neck pain can be treated with simple, conservative measures, like a combination of home exercises and over-the-counter medications.

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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. 

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.