Axial neck pain (pain exclusively in the neck, as compared to pain radiating down the arms) is caused by the complex interaction of muscles and ligaments. Also known as cervical strain, the condition frequently develops as a result of posture, sleep habits, ergonomics (e.g., computer monitor and bifocal position), stress, muscle fatigue, postural adaptation to other primary pain sources (i.e. shoulder) and cervical disc or facet joint (the joints of the spine) degeneration. Axial neck pain is the most common source of neck pain, as well as the most resolvable. Surgery is only necessary in rare cases caused by single- or two-level degenerative disc disease with severe, unrelenting pain. Most patients achieve relief over time and there is a high rate of resolution without treatment. In one study, after just three months of conservative treatment, 70 percent of the participants demonstrated complete or partial relief.

Signs of axial neck pain typically include pain or soreness in the back neck muscles with radiation to the occiput, shoulder or parascapular region. Also quite common are stiffness in one or more directions of motion and headache. Local warmth or tingling as well as localized areas of muscle tenderness (trigger points) may also be encountered. Initially, a very common secondary symptom is headaches, and often such symptoms are interpreted and treated as migraines without success.