How Does Severe Neck Pain Develop?

Severe neck pain can take many forms, such as feeling sharp, burning, and/or electric shock-like. While severe neck pain could indicate a serious issue or medical emergency, it could also stem from a problem that is not serious or cannot be identified. Here is a rundown of various underlying problems that can potentially cause severe neck pain, including muscle spasm, spinal joint dysfunction, spinal nerve compression, and vertebral damage.

Video: Neck Pain Causes

Anatomical structures in the neck can wear down or become injured, causing pain and possibly pain that radiates down the arm. Watch Now

Muscle Spasm

When a muscle goes into an involuntary contraction, called a spasm, it becomes tight and potentially painful. A neck muscle spasm may involve constant or throbbing pain that feels sharp or burning. It can also cause a stiff neck and prevent head motion in one or more directions.

See Understanding Neck Spasms


Some of the causes of neck muscle spasms are not well understood. Potential causes could include:

  • Neck strain or sprain
  • Overexertion or fatigue
  • Underlying spinal condition, such as herniated disc or osteoarthritis

Other factors may also be involved in neck muscle spasms. While neck muscle spasms typically subside within a few minutes, they can last longer or even become chronic.

See What Causes Neck Spasms?

When a muscle and its surrounding connective tissues are tight and refer pain upon touch, it is commonly considered a trigger point. A trigger point in the neck can refer severe pain to nearby areas, such as the shoulder or head.

See Could That Shoulder Pain Really Stem From the Neck?

Spinal Disc and/or Joint Dysfunction

Neck Pain
Neck Pain
(larger view)

When a facet joint and/or spinal disc starts to degenerate, inflammation and pain can develop. While specific pain pathways may vary, particular pain points may include:

  • Facet joint capsule. This capsule, made of strong fibrous tissue, encloses the joint space and helps hold the adjacent articular surfaces together. It also contains nerves that can become painful when the capsule is inflamed, overstretched, or torn.1
  • Annulus fibrosus. This protective outer layer of the disc also contains some nerve fibers. When the annulus fibrosus becomes torn or inflamed, it may become a source of neck pain.2

Injury or natural wear-and-tear may start this degenerative process. While it is possible for just a disc or facet joint to degenerate, they typically degenerate together. When a disc starts to breakdown, more stress is put on the nearby facet joints, and vice versa.

Watch Cervical Facet Osteoarthritis Video

Spinal Nerve Root Compression

Spinal nerve roots branch from the spinal cord and exit the spinal canal through bony openings called the intervertebral foramina. A spinal nerve root typically becomes inflamed or compressed because of a herniated disc, foraminal stenosis, and other spinal degeneration. Rare causes, such as spinal tumors, are also possible.

Watch Cervical Herniated Disc Video

Nerve pain can be severe and electric shock-like. In cases when a spinal nerve root is inflamed or compressed within the neck, the pain can radiate down into the arm, hand, and/or fingers. When neurological deficits are also present, such as arm numbness or weakness, it is called cervical radiculopathy.

Watch Cervical Radiculopathy Interactive Video

The spinal cord may also become compressed within the cervical spine. Pain and neurological deficits may be experienced anywhere beneath the level of spinal cord compression, including the legs.

Vertebral Damage

A vertebral fracture can potentially cause severe neck pain, especially if the fracture results in spinal instability. Vertebral fractures can occur due to weakened bones, such as from osteoporosis, or from a traumatic injury.

See Vertebral Fracture Symptoms

Vertebral bone pain may also occur as a result of an infection or spinal tumor. For example, a cancerous tumor can metastasize (spread) into a vertebra and cause a deep ache that worsens over time if left untreated.

Watch Spinal Compression Fracture Video

Severe Neck Pain Can Vary by Individual

Imaging studies have shown that the severity of spinal degeneration does not necessarily correlate with the severity of pain. For example, it is possible for a person without neck pain to have an MRI that shows significant spinal degeneration, while someone with severe neck pain may have no spinal degeneration as seen on an MRI.3 The reason for these discrepancies is unknown, but it may be related to how different people may not perceive pain in the same ways.


When to See a Doctor

Any unexplained severe neck pain that interferes with daily activities requires a call to the doctor. Seek immediate medical attention if neck pain is accompanied by any of the following:

  • Severe headache
  • Fever or chills
  • Radiating pain, tingling, numbness, or weakness in both arms and/or legs
  • Problems with balance or coordination
  • Loss of bowel or bladder control
  • Unexpected weight loss

When severe neck pain develops after major trauma, it also requires immediate medical attention.


  • 1.Ita M, Zhang S, Holsgrove TP, Kartha S, Winkelstein BA. The physiological basis of cervical facet-mediated persistent pain: basic science and clinical challenges. J Orthop Sports Phys Ther. 2017; 47(7):450-61. doi: 10.2519/jospt.2017.7255. 
  • 2.Peng B, DePalma MJ. Cervical disc degeneration and neck pain. J Pain Res. 2018; 11: 2853-7.
  • 3.Brinjikji W, Luetmer PH, Comstock B et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015; 36(4):811-6.