For some people living with multiple sclerosis (MS), neck pain and stiffness are sometimes unexpected and bothersome symptoms.

“Is having a sore (stiff) neck a symptom of MS? It’s been two weeks, and I’m not getting relief,” asked one MyMSTeam member. Another member replied, “Same here! I get constant headaches from it, too.”

Here is what you need to know about this symptom, including what it feels like, what causes it, and how to manage it.

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What Does Neck Pain and Stiffness Feel Like?

Several MyMSTeam members have shared their experiences with neck stiffness. “Does anybody else get stiff in the neck during their bad MS flares?” asked one member. “Yes,” another replied, “my neck gets stiff often.”

For some people, symptoms stay local to the neck. Members describe their pain as:

• Sore
• Tight
• Constant or occasional
• Movement-limiting

Others explain how neck pain seems to spread to their head, shoulders, and other parts of the body. Irritated nerves in the neck or MS-related nerve damage may be responsible, causing symptoms like:

• Sharpness
• Numbness
• Tingling
• Burning
• Electrical shocks

“I woke up a few days ago, and I have such horribly stiff shoulders and neck! I never hurt myself that I’m aware of, but it feels like the muscles in my back are pulsating,” explained one member.

Another member described developing what felt like a stiff neck limited by pain. They said, “When I turn my head to the right, I have pain from what feels like the back of my ear to the back of my head. Lifting my head off the pillow feels like the absolute worst!”

What Causes MS Neck Pain and Stiffness?

Neck discomfort can be related to MS, but not always. Usually, neck pain in MS can have two main causes: musculoskeletal issues involving muscles and joints or disease-related nerve injuries.

Musculoskeletal Issues

For people with MS, musculoskeletal neck pain is often linked to how your body moves to make up for weakness, lack of coordination, or other mobility issues. For example, one member shared that his neck stiffness worsened after using his wheelchair more often.

Age-related wear and tear can also affect bones, muscles, and shock-absorbing cartilage in the neck. For instance, many people with MS can develop foraminal stenosis. This condition causes spaces in the spine to narrow, which can cause local neck pain and nerve pain down the shoulders, arms, or hands.

Another common age-related condition is cervical degenerative disc disease, which is when the cartilage in the spine wears down over time. As cartilage becomes weaker or less flexible, bones in the spine can develop spurs, causing pain with neck movement. The spurs can irritate nerves in the spine and cause discomfort that travels into the arms, similar to foraminal stenosis.

Sometimes, neck pain can spark cervicogenic headaches. This is when neck pain spreads to the head, causing neck stiffness and one-sided head pain that radiates to the back of your head, ear, or eye. It can also make your neck feel stiff when you rotate or bend it.

Disease-Related Nerve Injury

Neck pain can also be caused by MS lesions (nerve damage). These injuries can create uncomfortable sensations in different parts of the body, including numbness, itching, burning, or stabbing pain.

MS lesions can also cause spasticity or spasms, which some MyMSTeam members said coincides with their neck pain. One member wrote, “I experience terrible headaches and neck pain that seem to be caused by my neck and shoulder muscle spasms.”

Some people experience Lhermitte’s sign, which is a common MS symptom or a sign of a possible relapse. Lhermitte’s sign is a brief stabbing pain that travels from your head down your spine — and sometimes your arms or legs — when you look down. If you notice it is a new or worsening symptom, report it to your doctor.

Managing Neck Pain and Stiffness With MS

There are several ways to treat neck stiffness and pain with MS. If you start experiencing neck discomfort, talk to your neurologist or healthcare team. They can look into the cause and work with you to find the best treatment options.

At-Home Relief

For musculoskeletal pain, simple home remedies can go a long way. Some MyMSTeam members have tried massage or temperature therapy. “I’ve found that heat in the morning and ice at night helps calm my neck pain,” wrote one member.

Others have tried fixing their sleep setup. “I used to think I slept wrong, but I got new pillows to better support my neck,” a member explained. Someone else wrote that they decided to upgrade their old mattress to find relief.

Some people may also benefit from relaxation techniques throughout the day or before bed to lower stress. Stress and anxiety are common among people with MS, but they can worsen physical symptoms, like fatigue and pain spasticity. If you’re not sure where to start, or if you need more support, consider seeing a mental health professional.

Physical Therapy

Staying active with neck discomfort can feel challenging, but avoiding movement can make pain and stiffness worse. Ask your neurologist if physical therapy is right for you. A physical therapist can help prescribe safe exercises and stretches to help you feel and move better.

During your first physical therapy session, your therapist will evaluate your symptoms and measure your neck movement. Then, they’ll create a treatment plan for you to perform at home to address weakness, range of motion, and pain. Every session, they reevaluate to see if you’re on track and adjust the treatment plan as needed.

They may have you do:

• Neck stretches and strengthening exercises
• Exercises to strengthen posture muscles
• Head and neck coordination activities
• Stretches that improve flexibility in closely related body areas, like the shoulders and upper back

The goal is to return to your daily activities with less pain and more mobility. Your physical therapist may also teach you ways to prevent future neck pain while managing MS.

Medications

In some cases, adjusting your medication regimen can help relieve neck pain or stiffness. The right medication depends on the cause.

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat MS-related nerve pain. Doctors use other types of medications that can help, including:

• Anti-seizure medications to stabilize nerve signals, like gabapentin, pregabalin, carbamazepine, and oxcarbazepine
• Antidepressants to dampen pain signals, like duloxetine or amitriptyline

Your doctor may prescribe muscle relaxants, like baclofen or tizanidine, if muscle spasticity is affecting your neck. If your doctor suspects your neck discomfort is caused by muscle strain or another musculoskeletal issue, they may suggest over-the-counter treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

Opioid medications, including tramadol, are recommended less often. People may become dependent on these medications, and they have limited long-term benefit.