Differential Diagnosis for Upper Neck Pain

The following is a list of potential diagnoses for upper neck pain, categorized by likelihood and potential impact.

• Single Most Likely Diagnosis
  • Musculoskeletal Strain: This is often the most common cause of upper neck pain, resulting from overuse, poor posture, or direct injury to the muscles and ligaments in the neck.
• Other Likely Diagnoses
  • Cervical Spondylosis: A condition involving wear and tear on the disks in the neck, which can cause pain and stiffness.
  • Tension Headache: Often involves the neck and can refer pain to the upper neck area.
  • Cervicogenic Headache: Pain referred from the cervical spine to the head, often involving the upper neck.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although rare, this condition, often due to an aneurysm rupture, can present with sudden severe headache and neck pain, and is life-threatening if not promptly treated.
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause severe neck pain and stiffness, along with fever and headache.
  • Cervical Spine Fracture: Especially in the context of trauma, a fracture can cause severe pain and potentially lead to neurological deficits if not addressed.
• Rare Diagnoses
  • Temporal Arteritis: An inflammation of the blood vessels, particularly those in the head, which can cause pain in the neck and scalp, especially in older adults.
  • Occipital Neuralgia: Involves the nerves that run from the neck up to the scalp and can cause sharp, stabbing pain.
  • Rheumatoid Arthritis: Although more commonly associated with joint pain, can also affect the cervical spine and cause neck pain.
  • Osteomyelitis or Discitis: Infections of the bone or disc in the spine, which are rare but can cause severe pain and require prompt treatment.

Each of these diagnoses has a distinct set of symptoms and risk factors, and a thorough medical history, physical examination, and sometimes imaging studies are necessary to determine the underlying cause of upper neck pain.