Stiff neck, also called meningismus, refers to a painful restriction or inability to move the cervical spine. This is caused by reflex tension to protect important structures of the spinal cord and brain. When stiff neck occurs, it is imperative to seek medical attention because stiff neck is a symptom (sign of disease).
What is stiff neck?
Neck pain is mostly the most obvious symptom of a pronounced neck stiffness. Neck stiffness means the affected person has significant pain when moving the head. The mobility of the cervical spine is severely restricted or no longer possible. The patient is unable to move the chin towards the chest. This is the main criterion for meningismus. The medical term meningism was derived from meninges. Meninges are the membranes of the brain. However, a stiff neck should be distinguished from pure neck pain or shoulder pain. Tension, however, usually occurs in association with meningismus.
Causes
Various causes are possible in meningismus. For example, diseases of the meninges, bleeding in the brain, sunstroke, or a flu-like infection can be the cause of stiff neck. Infection from a tick bite can also cause stiff neck. Hemorrhages in the brain are particularly dangerous and are also the first sign of illness to cause stiff neck. Suppurated sinusitis or suppurated tonsillitis can also be accompanied by stiff neck. Diseases or injuries of the cervical spine are also commonly coupled with painful neck stiffness. A migraine attack can also be the cause of stiff neck.
Symptoms, complaints, and signs
Meningismus initially causes discomfort in the neck. Sufferers complain of neck stiffness, accompanied by very severe pain, when trying to move the head toward the chest. For this reason, the affected persons adopt a protective posture, which in turn leads to painful tension of the neck muscles. In addition, characteristic accompanying symptoms occur, which, however, do not necessarily have to occur in every patient. These accompanying symptoms are called “meningonal syndrome”. The most frequent symptoms are sudden onset of nausea and even vomiting. Furthermore, extremely severe, cramp-like headaches are observed in many sufferers. If the meningismus is due to an infection, with meningococci for example, not rarely high fever occurs, which becomes steadily higher. More rarely, symptoms such as photophobia or phonophobia occur. In photophobia, those affected find any light sources unpleasant and painful. In some individuals, sensitivity to light can cause nausea and vomiting. With all these signs, a doctor should be consulted immediately, as it is a serious condition.
Diagnosis and course
The diagnosis at the onset of stiff neck must be made by a physician. For the physician, other diagnostic criteria include the appearance of fever, visual disturbances, and sensitivity to light. Important clues are given to the physician during the questioning of the patient and the first physical examination. Certain tests enable the physician to determine which meninges are diseased or irritated. Furthermore, blood tests and X-ray examinations give the physician initial clues as to the cause of the disease. Especially in combination with high fever, a cerebrospinal fluid puncture (lumbar puncture) is an important measure for doctors to make a diagnosis. Depending on the cause of the stiff neck, the course of the disease varies. Meningismus caused by inflammation of the meninges or bleeding can develop into a life-threatening disease and requires intensive medical care until the patient is stabilized. The course of the disease may be very dramatic, since in addition to stiff neck, considerable headaches, visual disturbances, nausea, dizziness, sensitivity to light and disturbances of consciousness may occur. These can lead to unconsciousness. Typical of meningismus is that the reflex tensions are released in coma.If the cause of stiff neck is damage to the cervical spine, headaches, partial vision problems, and insensitivity and loss of strength in the arms are possible.
Complications
Apart from the typical pain-relieving measures, which are effective almost all over the body, there is no way for sufferers to treat the stiff neck or make it more bearable. Thus, a medical investigation of the cause is necessary and accordingly the meningismus is then treated along with its cause. The neck stiffness should not be tried to overcome by force. Thus, in case of a cerebral hemorrhage as a cause, further severe damage can be caused by further hemorrhages. Also a bacterial cause as a trigger of meningismus can only be worsened by “straightening” the head, since purulent tissue is distributed further or cysts can rupture. Since stiff neck occurs for a variety of reasons, amateurish treatment with home remedies is not advised. For example, infections of the meninges – which usually indicate diseases requiring treatment – or cerebral hemorrhages are often the reason for the stiffness. In addition, damage to the spinal column can also be causative. The list of accompanying symptoms that occur depending on the cause is long. Those affected can only take action in the case of neck tension, which occurs in the course of a flu-like infection, by means of heat, cold or massage. In case of doubt, however, medical advice is still always preferable.
When should you go to the doctor?
A doctor does not have to be consulted in all cases of stiffness of the neck. Often, stiffness of the neck occurs due to incorrect posture, one-sided stress, as well as a lack of movement. By light compensatory movements and a heat supply of the affected place a clear relief of the complaints or a complaint liberty without a medical care can be reached. If self-initiated sporting activities are carried out that do not cause overexertion and gently loosen up the muscles in the neck, an improvement in the state of health is often achieved. Often, self-initiated massage can bring about mobility of the shoulders, neck as well as neck. If, despite all efforts, the discomfort continues unabated or increases in intensity, a visit to the doctor should be made. In case of headache, deformation of the skeleton, persistent relieving posture of the body or permanent crooked posture by the affected person, a doctor should be consulted. If there is any discomfort in chewing, shortness of breath or changes in the appearance of the skin, a doctor should be consulted. Medical help should be sought as soon as the symptoms that have occurred become widespread or daily requirements can no longer be met due to the impairments. Repeated nausea and recurrent vomiting are other signs that should be sought medical attention.
Treatment and therapy
Treatment of meningismus depends on the cause. Meningismus whose cause is an inflammatory disease of the meninges is treated with antibiotics and often with antiviral drugs. In this case, intensive medical care is often required, as significant complications, such as epilepsy, can occur during this condition. If the neck stiffness is caused by bleeding in the brain, it is imperative to clarify where exactly the bleeding is in the brain. Very fast action by neurosurgeons is required here, as the bleeding can lead to damage to the brain that is no longer reversible. Furthermore, bleeding in the brain can lead to breathing problems and death of the patient within a very short time. Especially in cases of bacterial infections, such as a purulent angina, the symptoms improve quite quickly with the administration of antibiotics, and the neck stiffness disappears. Neck stiffness that occurs due to diseases of the cervical spine requires clarification of which structures of the cervical spine are damaged. Depending on the results of this examination, a specific therapy in the form of medication and physiotherapy is then carried out. In the case of severe herniated discs, which can also be accompanied by stiff neck, surgery is often required.
Outlook and prognosis
Meningismus is caused by a potentially life-threatening condition. Therefore, the prognosis depends primarily on what causes the disease and how quickly those affected receive professional treatment.Especially if the disease is of bacterial origin, it must be treated quickly with antibiotics. Because otherwise, if left untreated, it almost always ends fatally. With timely treatment, however, there is a good chance that patients will recover completely. However, the chances of a full recovery depend on the type of pathogen as well as the general state of health of the affected person. Accordingly, a prognosis is sometimes less favorable for seniors and for infants. Their immune system is usually not as efficient as in healthy adults. A disease caused by viruses is much less life-threatening. Nevertheless, the prognosis here also depends on the particular virus as well as the general physical condition. The first few days in particular are critical. However, if the patient has survived these well, the chance of recovery is usually good. The disease then usually heals within several weeks without any consequential damage. In rare cases, the disease can cause lasting neurological damage. This can be paralysis, hearing damage or impairment of psyche or behavior. Complications as well as long-term damage usually occur when the disease also spreads to the brain.
Prevention
Direct prevention of meningismus is not possible. Certain vaccinations can reduce the risk of contracting the disease or meningitis after a tick bite. Cervical spine damage can be prevented by varied activities, gymnastics and plenty of exercise. In order to prevent vascular changes in the brain, which under certain circumstances can lead to a life-threatening hemorrhage in the brain, it is important to avoid high-fat foods, nicotine and obesity. Furthermore, it is important to ensure that blood pressure is not elevated. Through regular screening, it is very rarely possible to detect changes in the vessels, so that in individual cases, meningismus can be avoided through early treatment.
Follow-up
The extent to which follow-up care becomes necessary depends on the outcome of initial therapy. Usually, no sequelae remain if treatment is started in a timely manner. Therefore, there is no reason for close follow-up as known from cancer treatments. A recurrence cannot develop from the underlying disease. Only a few measures are suitable to prevent a recurrence of the neck stiffness. As part of follow-up care, a physician can reduce the risk of recurrence through certain vaccinations. Other forms of prevention, on the other hand, are the responsibility of the patient. For example, a healthy lifestyle with plenty of exercise, a balanced diet and no substance abuse is considered the best type of preventive aftercare. Aftercare pursues other goals if consequential damage from the initial treatment remains. In this case, the aim is to support everyday life and minimize disadvantages. Also, no new complications should occur. The extent and type of aftercare depends on the individual symptoms. For example, aids can be prescribed for hearing impairments. Behavioral problems can be treated as part of psychotherapy. Neurological damage and paralysis can even lead to a lifelong need for assistance. Most patients with permanent impairments are also treated with medication.
Here’s what you can do yourself
To alleviate the discomfort and avoid danger can be contributed in the case of stiff neck by own behavior. It should also be noted that natural straightening of the head can be dangerous due to the condition and must therefore be avoided. This also applies to intensive sports activities, especially gymnastic exercises. A rather restrained reaction to painful neck tension with heat or cold as well as light massage is helpful. It is also advantageous to design the workplace according to ergonomic principles. The appropriate choice of chair and table should be a priority when performing office work. Regular breaks with a little movement help to prevent existing complaints from being aggravated by prolonged, unchanged sitting postures. For car journeys, it is important to remember that a sudden impact of the head and neck on the attached neck support could be painful and dangerous. A properly adjusted, well-padded neck support is therefore recommended. Unnecessary stress in everyday life for the neck and spine area should be avoided.This includes incorrect posture, stress and drafts. Choosing the right mattress and pillow can promote a night’s rest that is as pain-free as possible. If the neck stiffness is accompanied by a chronically occurring pain, a patient attitude is required. Relaxation techniques can help to cope better psychologically with the condition.
