The back of my neck hurts when i swallow

Doctors agree that there is a close link between sore throats and neck pain. The throat and neck are intertwined, and pain in the muscles of the neck can affect the throat. In the same way, a swelling in the throat, or a sore throat, can affect the neck, and cause neck pain. When you’re feeling sick, either with a common cold or flu, you’ve probably noticed that you have both a sore throat and neck pain. Illnesses that affect either the throat or the neck will affect the other.

Infection

A common cause of a sore throat, along with flu symptoms and neck pain, is an infection. Both bacterial and viral infections can lead to painful swelling in the throat or the tonsils, and this swelling often leads to neck pain. Infections such as a common cold or flu, strep throat, or tonsillitis, can all cause very sore throats and a lot of neck pain.

Infections trigger your body’s natural immune response, producing more white blood cells to attack the infection. The lymph nodes on the sides of your neck, right under your jaw, produce these cells, and the area swells as more oxygen-rich blood is directed to the lymph nodes in order to fight the infection. The lymph nodes will also filter out any harmful particles in the blood, and all this increased activity will lead to a sore throat and neck pain. 

Infections will often pass on their own, but more severe infections are treated with antibiotics.

Gastroesophageal Reflux Disease

Sore throats and neck pain can be caused by gastroesophageal reflux disease (GERD), commonly called acid reflux. Stomach acids, fluids, or even food particles can travel from the stomach back up the esophagus to the throat. This irritates the lining of the throat, contributing to a sore throat, uncomfortable swelling, and even neck pain. You may have acid reflux if you suffer from heartburn, have a hard time swallowing, or feel as if there’s a painful lump in your throat that won’t go away.

Treating acid reflux is best achieved through changes in diet and lifestyle. Eating more lean meats and more vegetables will help you control acid reflux on your own. Weight loss will also reduce acid reflux, so make a few simple lifestyle changes, to manage acid reflux. Some medications can also effectively treat acid reflux, and relieve sore throats and neck pain. 

Allergies

Allergies can contribute to both sore throats and neck pain. The most common allergies include:

• Airborne allergens such as pollen
• Pet dander
• Dust mites
• Mold or mildew
• Food allergies such as nuts, milk, or gluten 

When you’re exposed to airborne or food allergies, you’ll often experience a dry, sore throat and neck pain. Other symptoms include sneezing, a stuffy nose, hives, or swelling.

Treatment starts with removing the source of the allergen from the air in the home, avoiding outside allergens that are most common in the spring, and avoiding eating food allergens. Antihistamines can also manage symptoms, and stop sore throats and neck pain. 

Tumors

Tumors are another cause of both sore throats and neck pain. Both benign and cancerous tumors in the neck or head can cause sore throats and neck pain. Common symptoms of tumors in the neck or head are:

• A sore throat
• A headache
• Swelling in the face, jaw, or neck
• A lump anywhere on the head or neck
• Numbness in the neck or the face

It’s very rare to have a tumor, but if you’ve been experiencing a persistent sore throat or neck pain, check for any of these additional symptoms. Both benign and malignant tumors must be surgically removed. 

Visiting An ENT

Have you had persistent sore throats and neck pain? If you’ve only had these symptoms for a few days, you probably have a cold, or mild infection. Stay home from work if you can, get lots of rest, and drink lots of fluids, such as hot tea. In a few days you should be back on your feet. 

However, if the symptoms persist, or you notice any new symptoms that aren’t normal for a common cold, visit your doctor or ENT as soon as possible. Home remedies and mild painkillers won’t bring relief from major symptoms, and you’ll need to seek medical attention.

Painful swallowing is any pain or discomfort while swallowing. You may feel it high in the neck or lower down behind the breastbone. Most often, the pain feels like a strong sensation of squeezing or burning. Painful swallowing may be a symptom of a serious disorder.

Swallowing involves many nerves and muscles in the mouth, throat area, and food pipe (esophagus). Part of swallowing is voluntary. This means you are aware of controlling the action. However, much of swallowing is involuntary.

Problems at any point in the swallowing process (including chewing, moving food to the back of the mouth, or moving it to the stomach) can result in painful swallowing.

Swallowing problems can cause symptoms such as:

• Chest pain
• Feeling of food stuck in the throat
• Heaviness or pressure in the neck or upper chest while eating

Swallowing problems may be due to infections, such as:

• Cytomegalovirus
• Gum disease (gingivitis)
• Herpes simplex virus
• Human immunodeficiency virus (HIV)
• Pharyngitis (sore throat)
• Thrush

Swallowing problems may be due to a problem with the esophagus, such as:

• Achalasia
• Esophageal spasms
• Gastroesophageal reflux disease
• Inflammation of the esophagus
• Nutcracker esophagus
• Ulcer in the esophagus, especially due to tetracyclines (antibiotic), aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxyn

Other causes of swallowing problems include:

• Mouth or throat ulcers
• Something stuck in the throat (for example, fish or chicken bones)
• Tooth infection or abscess

Some tips that may help you to ease swallowing pain at home include:

• Eat slowly and chew your food well.
• Eat pureed foods or liquids if solid foods are hard to swallow.
• Avoid very cold or very hot foods if they make your symptoms worse.

If someone is choking, immediately perform the Heimlich maneuver.

Contact your health care provider if you have painful swallowing and:

• Blood in your stools or your stools appear black or tarry
• Shortness of breath or lightheadedness
• Weight loss

Tell your provider about any other symptoms that occur with the painful swallowing, including:

• Abdominal pain
• Chills
• Cough
• Fever
• Heartburn
• Nausea or vomiting
• Sour taste in the mouth
• Wheezing

Your provider will examine you and ask about your medical history and symptoms, including:

• Do you have pain when swallowing solids, liquids, or both?
• Is the pain constant or does it come and go?
• Is the pain getting worse?
• Do you have difficulty swallowing?
• Do you have a sore throat?
• Does it feel like there is a lump in your throat?
• Have you inhaled or swallowed any irritating substances?
• What other symptoms do you have?
• What other health problems do you have?
• What medicines do you take?

The following tests may be done:

• Endoscopy with biopsy
• Barium swallow and upper GI series
• Chest x-ray
• Esophageal pH monitoring (measures acid in the esophagus)
• Esophageal manometry (measures pressure in the esophagus)
• Esophagogastroduodenoscopy (EGD)
• HIV testing
• Neck x-ray
• Throat culture

Swallowing - pain or burning; Odynophagia; Burning feeling when swallowing

Allen CT, Nussenbaum B, Merati AL. Acute and chronic laryngopharyngitis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 61.

DeVault KR. Symptoms of esophageal disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Pandolfino JE, Kahrilas PJ. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 44.

Wilcox CM. Gastrointestinal consequences of infection with human immunodeficiency virus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 35.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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