Stiff Neck and Headache

Introduction

If Stiff Neck and Headache occur together then there is a likelihood of having something serious (but not always).

The neck gets stiff when its muscles are tight or are under tension. This will reduce the flexibility of the neck, sometimes in all directions, other times only in one direction, for example for flexion only (affecting bending the neck forward).

Some serious conditions that can cause both stiff neck and headache together

• Meningitis
• Encephalitis
• Subarachnoid hemorrhage

Some generally non serious conditions with the above 2 symptoms together

• Tension headache
• Certain types of migraine headache
• Whiplash injuries
• Cervical spine arthritis, degenerative disc disease
• Herniated disc in the upper cervical spine
• Occipital neuralgia etc

When I used the term “non serious” above I just meant that these conditions are generally not life threatening however these nonserious conditions still may be of some concern and also the stiffness and soreness in the head and neck area can bother the patient considerably.

The serious conditions mentioned above should be recognized as quickly as possible because the mortality rate (death rate) is high for all the above mentioned serious conditions.

How to analyze these symptoms?

When a patient comes with these 2 symptoms (stiffness in the neck area and headache) along with fever then chances are high that it might be neuroinfections like meningitis or encephalitis. Meningitis is the inflammation of the meninges (the brain coverings) and encephalitis is the inflammation of the brain tissue itself.

Between the above two conditions it is the meningitis that will produce more frequent and more consistent stiffness of the neck. Along with the stiffness in the neck region if patient’s consciousness and awareness are intact then it is more likely meningitis rather than encephalitis. If consciousness and awareness are affected then it is most likely encephalitis and if seizures are also present from the beginning then encephalitis is the most likely diagnosis.

If fever is absent then the above 2 possibilities (meningitis or encephalitis) are very less likely although not completely ruled out but the absence of fever certainly raises the suspicion for Subarachnoid hemorrhage because this is the classic example for neck stiffness and headache together occurring in a patient but in the absence of fever. It is commonly due to rupture of berry aneurysm (brain or cerebral aneurysm).

In these conditions especially the typical meningitis the stiffness is more during flexion of the neck rather than in any other direction but this is not always easy to prove during the clinical examination. If neck pathology is the cause for stiffness then the stiffness may be experienced in all directions of neck movement.

Patients with migraine, tension headache etc generally present with some typical manifestations related to those conditions and they help in arriving at the correct diagnosis.

Patients with neck pathologies may have motor, sensory and pain symptoms in their arms, and if spinal cord injury too is present then there may be symptoms in the legs too, and possibly bowel and/or bladder symptoms as well.

Diagnosis

A non contrast head CT usually shows subarachnoid bleed (but not always). A CSF (cerebrospinal fluid) study generally confirms the diagnosis of subarachnoid hemorrhage as well as of meningitis and encephalitis too.

For the diagnosis of primary neck pathologies like arthritis, disc pathologies, spinal stenosis etc an MRI or CT scan of the neck/cervical spine area is ordered.

Treatment

Obviously the treatment will depend upon what caused these symptoms (headache and stiffness in the neck area).

For meningitis antibiotics are used. For encephalitis especially the herpes encephalitis acyclovir is used.

For subarachnoid hemorrhage supportive care along with nimodipine is used. An angiogram will help in identifying the berry aneurysm that bled. The berry aneurysm if identified is generally treated either with surgery (clipping) or interventional radiology techniques (coiling etc).

Primary neck pathologies are treated accordingly, for example treatments like physical therapy, pain meds, muscle relaxants, heat and cold compressors, epidural steroid injections etc are used for primary neck pathologies like disc herniations, arthritis, spinal stenosis etc and if the neck pathology is advanced or serious then surgery may also may be needed.

Conclusion

The combination of symptoms like stiff neck and headache together in a patient do not necessarily mean something is always ominous however such possibilities of above mentioned serious conditions exist so patients with symptoms of stiff neck and headache together should get checked by a doctor at the earliest.



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