A stiff neck can be experienced during a COVID-19 infection, though it is not one of the most common or distinguishing symptoms. The stiffness is typically a manifestation of myalgia, or generalized muscle aches, which is a frequently reported symptom of the infection. Recognizing this context helps differentiate between a common viral response and a sign of a more serious health concern.
Stiff Neck as a COVID-19 Symptom
The stiff neck experienced during a COVID-19 infection is usually a result of widespread muscle pain, known as myalgia, which can affect the neck, shoulders, and back. This muscle soreness is a common symptom, reported by approximately 11% to over 60% of people with COVID-19 in various studies, although the prevalence varies widely depending on the variant and population studied. The stiffness is often part of a general feeling of body aches that appears early in the course of the disease, often alongside fever and fatigue.
Scientific evidence suggests two main reasons for this muscular pain. First, the virus that causes COVID-19, SARS-CoV-2, may interact with angiotensin-converting enzyme 2 (ACE2) receptors found in muscle tissue, potentially causing direct damage. Second, the body’s immune response triggers a cascade of inflammatory reactions, leading to the release of compounds like Interleukin-6 (IL-6) that cause widespread muscle and joint pain. This inflammation is the body’s way of fighting the infection.
In most cases, this neck stiffness is muscular in nature and resolves on its own as the infection clears, usually within a few days or weeks. This type of stiffness is typically accompanied by generalized soreness in other large muscle groups, such as the back or shoulders. It may also be indirectly caused by spending extended time in bed due to illness, which can lead to muscle tension and stiffness.
Differentiating Causes of Neck Stiffness
While COVID-19-related stiffness is usually muscular, a stiff neck can also be a warning sign for other, more urgent medical conditions. The muscle pain from a viral infection often presents as a dull, widespread ache that allows for some range of motion, although movement may be uncomfortable. This muscular stiffness tends to have a gradual onset and often feels similar to a strained muscle.
In contrast, a stiff neck that signals a serious condition like meningitis—inflammation of the membranes covering the brain and spinal cord—is characterized by severe stiffness known as nuchal rigidity. This neurological stiffness makes it extremely difficult or impossible to bend the chin down toward the chest. The stiffness is a profound inability to flex the neck forward due to irritation of the meninges.
Meningitis-related stiffness is almost always accompanied by other severe symptoms distinct from typical COVID-19 myalgia. These include a severe headache that does not respond to common pain relievers, a high fever, and photophobia (pronounced sensitivity to light). A person with neurological involvement may also appear acutely ill, experience mental confusion, or develop a rash.
The presence of a severe headache combined with a rigid neck that limits chin-to-chest movement should prompt immediate medical evaluation, regardless of a potential COVID-19 diagnosis.
Actionable Steps and Emergency Warning Signs
If you experience neck stiffness during a presumed or confirmed COVID-19 infection, the initial steps involve supportive home care for muscular discomfort. Rest, staying well-hydrated, and using over-the-counter pain relievers like ibuprofen or acetaminophen can help manage the generalized muscle aches. Applying heat or cold packs to the neck area and performing gentle, light stretches can also alleviate the tension.
Monitor for specific red flag symptoms that suggest the stiffness requires immediate medical attention. Seek emergency care if the neck stiffness is so severe that you cannot touch your chin to your chest. Other warning signs include a severe, sudden headache, mental confusion, difficulty waking up, vomiting, or a fever accompanied by cold hands and feet.