MS and neck pain often go hand in hand, and they can feel like one more thing you’re expected to “just deal with.” And when imaging looks “fine,” it’s easy to feel dismissed. The truth is: neck pain in MS is common, real, and often multi-factorial, meaning it can come from the nervous system, the muscles/joints, or (most often) a mix of both. Pain is also one of the most common symptoms people report in MS overall, and it can affect quality of life, mood, sleep, and activity levels
Below are five evidence-informed reasons “multiple sclerosis neck pain” happens, and provide you with clear, non-surgical ways to potentially start lowering the pain intensity.
Why Do MS and Neck Pain Occur Together?
Research suggests MS and neck pain are commonly tied together. In one cross-sectional study, cervical spine pain was reported by 67.5% of people with MS in the sample. Another study looking at musculoskeletal pain distribution in MS reported neck pain in 41.7% of participants over the prior 12 months.
Why the overlap?
MS can change how the brain and spinal cord send signals, inherently affecting muscle tone, coordination, sensation, and fatigue. Those nervous-system changes can lead to muscle guarding, altered posture, and higher sensitivity to normal movement, all of which can stack up in the cervical spine.
1) Spasticity and High Muscle Tone Can Pull On The Neck
Spasticity (involuntary tightness/over-activity of muscles) is common in MS and can show up as stiffness, spasms, or pain. Reviews estimate spasticity affects roughly 60–84% of people with MS, and it can include pain and a sense of tightness. Another review notes spasticity occurs in more than 80% of people with MS at some point and is associated with pain and contractures.
Even if your “main” spasticity is in the legs, the nervous system doesn’t isolate symptoms neatly. When the body is working harder to stabilize, you may unconsciously recruit neck and shoulder muscles to help you balance or move—creating chronic tension and stiffness.
What helps (often alongside meds): targeted neuro-rehab to reduce over-recruitment of muscles, gentle mobility work, and strategies that calm the system so muscles don’t stay “on” all day.
2) Fatigue and Weakness Can Change Posture
MS fatigue is not “normal tired.” It can change how your body holds itself up against gravity. especially late in the day. When stabilizing muscles fatigue, many people drift into forward head posture, shoulder hiking, or bracing. That doesn’t mean you’re doing anything wrong. It means your system is adapting.
Pain studies in MS repeatedly show relationships between pain and fatigue, and between pain and mood, highlighting how closely symptoms can interact.
Key point: posture is rarely a “willpower problem.” In MS, it’s often a capacity problem, where your brain and body are running out of bandwidth.
What helps: micro-breaks, better workstation setup, supported resting positions, and strengthening that’s appropriate to your nervous system bandwidth (not pushed to exhaustion).
3) Nerve-Driven Pain and Sensory Changes Can Amplify Neck Symptoms
Some MS and neck pain is musculoskeletal (sore joints, tight muscles). But MS can also cause neuropathic pain, which is pain driven by nervous system lesions or altered sensory processing. Reviews describe MS pain syndromes ranging from musculoskeletal pain to central neuropathic pain and paroxysmal symptoms like Lhermitte’s phenomenon.
This matters because nerve-driven pain can feel “out of proportion” to movement: light touch, holding your head up, or gentle stretching may feel surprisingly intense.
What helps: matching the strategy to the pain type. Neuropathic pain often responds best to a blend of medical care plus graded rehab, sensory-friendly movement, and regulation strategies rather than aggressive stretching or “cranking” on the neck.
4) MS and Neck Pain Can Cause Headaches
Many people with MS and neck pain also deal with headaches, especially migraine and tension-type headaches. When headaches flare, it’s common to brace the jaw, upper traps, and the small muscles at the base of the skull, often fueling neck stiffness and pressure.
A practical clue: if your neck pain rises and falls with headaches, screen time, stress, or sleep disruption, it may be more “system-driven” than injury-driven, meaning it can improve with the right plan.
What helps: reducing triggers (light/screen ergonomics, hydration, pacing), improving neck/shoulder endurance gently, and addressing breathing patterns that keep the upper chest and neck muscles doing too much.
5) Stress, Sleep Disruption, and Constantly “Going” Can Keep The Neck Guarded
Stress doesn’t mean your MS and neck pain is just merely “in your head.” It means the nervous system is more likely to stay in a protective state, causing tight muscles, shallow breathing, lower pain threshold. Pain research in MS consistently shows associations between pain and fatigue, mood, and quality of life.
If you’ve been told “just relax,” you already know that advice isn’t helpful. The goal isn’t forcing you to just be more “calm”, it’s about building skills that help your system downshift more reliably.
What helps: paced activity, consistent sleep/wake timing when possible, breath practice that doesn’t provoke dizziness, and rehab that respects your nervous system (not just your muscles).
Is MS and Neck Pain Occurring Together Normal?
Neck pain can happen without a relapse. But it’s worth knowing the difference between:
More consistent with mechanical / musculoskeletal pain
- Varies with posture (phone/computer), lifting, or sleep position
- Improves with heat/cold, gentle movement, or rest
- Feels tight/achy and localized, sometimes with tension headache patterns
More concerning for relapse activity (or needs medical check-in)
A commonly used clinical definition of relapse is new or worsening neurologic symptoms lasting ≥24 hours, separated from a prior attack by ≥30 days, without fever or infection. Neck pain alone isn’t a classic relapse symptom—but neck pain with new neurologic changes deserves attention.
Call your medical team promptly if neck pain comes with:
- New weakness, new numbness, new balance loss, or new vision symptoms
- Fever/infection symptoms (because infection can mimic or worsen MS symptoms)
- A new “electric shock” sensation with neck flexion (Lhermitte’s sign is a recognized MS-related paroxysmal symptom)
Also note: temporary symptom worsening from heat/temperature changes is common in MS (often called heat sensitivity). That can make pain feel “flare-like” even when it isn’t new inflammatory-based activity.
Why Medication Doesn’t Always Fix Neck Pain in MS
Medications can be essential for spasticity or neuropathic pain, but neck pain often has layers: muscle tone + movement habits + fatigue + nervous system sensitivity. A large spasticity registry study found spasticity severity affected quality of life and daily activity choices, and treatment patterns varied widely. Meds can be part of the solution, but they usually don’t retrain how the body moves and holds your posture.
Evidence-Informed, Non-Surgical Options for MS and Neck Pain
1) Neurologic Rehabilitation (Brain-Body Retraining)
Neuro rehab aims to improve coordination, reduce guarding, and build movement confidence, especially when symptoms are driven by the nervous system as much as the tissues. This should be targeted, personalized, and done at a pace that you can handle structurally, neurologically, and metabolically. This can be especially important for neck pain, tension, and headaches.
2) Gentle, Consistent Movement (At The Right Pace)
A systematic review and meta-analysis found some evidence that exercise interventions can reduce pain in MS compared with passive controls, though study quality varied among participants. If you’re afraid exercise will trigger relapse, an updated systematic review/meta-analysis found no higher relapse risk in exercise-training RCTs that reported safety outcomes. Movement is the language of the brain, which is why exercise should always be a core part of any therapy or treatment program.
3) Postural Support and Improving Ergonomics (Support = Pain Relief)
It’s best to aim for postural variety throughout the day with changes in positions, support arms, raised screens, and reduced prolonged “head-down” time. This reduces load on tired muscular stabilizers and will give your spine some much-needed relief.
4) Hands-On Care (When Appropriate)
Manual techniques may support comfort and movement quality for some people. Cervical mobilization has been studied as an add-on to rehab in MS, showing improvements in proprioception, balance, and gait in a small randomized crossover trial. Keep in mind that this doesn’t mean everyone needs mobilization, and it’s not a cure. It’s just another tool that may fit certain presentations.
5) Temperature-Controlled Pain Relief (If Needed)
Heat may feel great for muscles, but many people with MS are temperature sensitive, with temporary symptoms worsening in warmer conditions. It’s best to consider lukewarm heat, shorter durations, or cooling strategies if heat flares symptoms.
How The Neural Connection Treats MS and Neck Pain
At The Neural Connection, we focus on non-invasive, personalized neurologic rehabilitation, especially for people who feel like they’ve been bounced between appointments without a clear plan.
Depending on your needs, treatment and care may include the following:
- A thorough assessment to identify your drivers (spasticity patterns, posture endurance, sensory sensitivity, headache links, fatigue load)
- Gentle neuro-based exercises to improve coordination and reduce protective guarding
- Pacing and nervous-system regulation strategies you can actually use day-to-day
- Ergonomic coaching and practical home routines that don’t require “pushing through”
- When appropriate, hands-on techniques to support mobility and comfort
- Non-invasive modalities and therapies to improve your pain, tone, and ROM
Our goal is not to minimize your symptoms; It’s to address the root causes, help you understand your body, and build a plan that fits your real life needs.
And our 130+ 5-Star Google Reviews from satisfied patients is a testament to our dedication to finding solutions.
If you’re still dealing with chronic headaches and neck pain from MS, we would love to help you!
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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.
