Question

What would cause a very severe stiff neck? I am a 60-year-old woman. I woke up one morning with it. I have no back pain or shoulder pain. I do have arthritis and take an NSAID (Daypro) for it, but it doesn't seem to help the neck pain.

Answer

There are many possible causes of a stiff neck, and without a full examination, I cannot possibly determine the exact cause. But two of the many possible causes of stiff necks - spasmodic torticollis and wryneck - are worth discussing.

Spasmodic torticollis (ST) afflicts approximately 3 in 10,000 people. More than 83,000 people in the United States currently suffer from it. This movement disorder is a dysfunction of the brain. The symptoms are limited to intermittent or sustained contractions of the muscles around the neck that control the position of the head. This causes the head to lean to one side, or be pulled forward or backward. The shoulders may also be uneven and some patients experience tremors in the head or arms. It is usually accompanied by constant and extreme pain. Although it's not related, ST can resemble other disorders including Parkinson's disease, epilepsy, muscular dystrophy and wry neck - an acute episode of pain and spasm in the neck that resolves itself in days or weeks. ST can limit a person's ability to function, but it's a localized disability that doesn't affect other body systems. Because it can be more severe during times of anxiety or stress, ST was once thought to be a psychiatric disorder, but in fact it does not affect the mind.

ST movements often disappear in sleep and can be relieved from 10 minutes to 4 hours after waking. Because of this, many people find relief by lying on their back. Touching the opposite side of the face or chin may also cause spasms to cease temporarily. Spontaneous recovery can be found in up to 20% of people within 5 years of onset, although this is more common in those afflicted before 40, or with a milder form. There is no uniform treatment for ST, but medications are usually the first line of defense. Should these fail, the approved treatment of choice is chemo-denervation, which involves Botulinum toxin (BOTOX) injections in the contracting muscles. This has proved to be a safe and effective method of relieving pain and lessening spasms. Surgery is not recommended as an initial defense, but it can be helpful for people who are unresponsive to other treatments. The approved procedure, known as selective denervation, is difficult to perform and sometimes does not provide relief. Surgically severing the muscles does not work. Often treatment of ST is through a multidisciplinary approach combining medications, BOTOX, physical and occupational therapy, biofeedback and electrical stimulation.

Wry neck is a condition where the neck suddenly becomes stiff and painful or stiff upon waking in the morning. Turning the head to the side (usually one side more than the other) and looking up can cause a severe "catching" pain. The muscles on one or both sides of the neck may also go into spasm and pain may be felt from the base of the skull right down to the shoulder blade and outwards to the top of the shoulder.

There are numerous possible causes. They include: poor sleeping posture, a sudden flicking or jerk of the head, a viral infection, and exposure to cold wind. In most cases, if treated immediately, a wryneck responds exceptionally well to treatment in 3-4 days. Massage, trigger point therapy and heat are applied to loosen the neck joints and reduce the muscle spasm. Home exercises can also be prescribed.

Precautionary measures: don't go out in the cold without being well wrapped-up, don't sit or lie with the neck in an awkward position, keep warm, use a hot water bottle wrapped in a towel or hot showers for relief, keep the neck moving within the limits of pain, and take pain killers (NSAIDs) such as ibuprofen.

Again, it is critical that you are seen and examined by your own doctor to make sure of your exact diagnosis, as some causes of stiff necks may not respond and may in fact worsen with the treatments for the wrong sort. . . . .