Pain from ankylosing spondylitis usually starts in the lower back. Over time, back pain spreads upward into the neck and sometimes to other parts of the body as well.

Members of MySpondylitisTeam frequently discuss neck pain. “If I sit for more than an hour, my tailbone and neck hurt,” wrote one member. Others say the pain is exhausting and depressing.

One member described the intensity of their pain: “Neck pain brings tears to my eyes. The pain is so bad it feels like my head’s going to rip off my neck. I can’t hold my head up.” Another member wrote, “I also have extreme tenderness in my head and neck, which brings up some scary symptoms. I can’t even walk a mile because of this.”

If ankylosing spondylitis is becoming a pain in your neck, you’re not alone. Here’s how to manage this common symptom and get some much-needed relief.

What Causes Neck Pain in Ankylosing Spondylitis?

Neck pain and stiffness from ankylosing spondylitis can happen when lower back pain moves up the spine into the neck. This can take several months or even years. Sometimes, though, the pain starts in the neck instead of the lower back. According to the Spondylitis Association of America, this pattern is more common in women than in men.

Neck pain caused by ankylosing spondylitis is a type of inflammatory pain. This kind of pain is different from mechanical pain, which happens when the back muscles are stressed or strained, like after lifting something heavy. A key difference between these two types of pain is that mechanical pain usually gets better with rest, while inflammatory pain often improves with movement and feels worse during rest.

Symptoms like neck pain may come and go. You may have more pain and stiffness at certain times of the day, such as first thing in the morning. Sometimes symptoms go away for a while and then come back again. Periods when symptoms are most active are known as flare-ups. Along with neck pain, people may have other symptoms of ankylosing spondylitis, including fatigue and hip stiffness.

Ways To Manage Ankylosing Spondylitis Neck Pain

Don’t hesitate to tell your healthcare provider about neck pain. There are several treatment options that may help. These include medication, physical therapy, home remedies, and, in some cases, surgery — depending on your needs.

Medications

Doctors usually recommend starting treatment for ankylosing spondylitis with over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help relieve neck pain, stiffness, and inflammation in the short term. Keep in mind that they also come with side effects and might not be ideal to use every day.

If NSAIDs don’t help, your doctor may suggest other treatments. These include biologics, which help calm the immune system, and Janus kinase (JAK) inhibitors, which block signals that cause inflammation.

If ankylosing spondylitis also affects joints outside the spine, your doctor may prescribe a disease‑modifying drug. One option is sulfasalazine, which can help control the disease over time. Sulfasalazine is not officially approved for ankylosing spondylitis but is sometimes used off‑label. Off‑label use means a drug is prescribed for a condition it isn’t officially approved to treat, but doctors may use it if it has been shown to help.

Steroid treatments can provide quick but temporary relief. Your healthcare provider may inject the medication directly into the affected area to reduce inflammation and pain, give it by mouth, or administer it intravenously (through a vein).

Surgery

Most people with ankylosing spondylitis never need surgery. In rare cases, if pain is severe and other treatments aren’t enough, surgery may be considered to improve neck movement and relieve pressure. A procedure known as an osteotomy may be used to cut and realign curved vertebrae, sometimes followed by fusion to straighten the spine. Another option, known as a laminectomy or decompression surgery, may be performed to relieve pressure on the spinal cord or nerve roots.

The decision to have surgery should involve your rheumatologist and a specialist, such as a spinal surgeon. Your rheumatologist can help you understand whether you might be a good candidate for surgery. Talk to your medical team early to learn about the potential for surgery now or in the future.

Exercise

Regular exercise can help you keep or improve neck movement and ease pain. It also offers added benefits that may reduce pain and stiffness, such as better posture, stronger muscles, and improved sleep.

There are several types of exercise that may be appropriate for people with ankylosing spondylitis, such as swimming, yoga, Pilates, and tai chi. The National Axial Spondyloarthritis Society offers online exercises tailor-made for people with ankylosing spondylitis.

As always, ask for your doctor’s medical advice before beginning a new exercise routine. They may want to refer you to a physical therapist who can help you learn exercises that are safe for you.

Physical Therapy

Physical therapy can be an important part of managing neck pain caused by ankylosing spondylitis. A physical therapist can show you exercises that build strength and keep your neck flexible. They can also teach you good posture to ease pressure on your neck.

Meditation

Regular meditation may help ease neck pain. Several members of MySpondylitisTeam use meditation to ease their symptoms. One member shared, “All it is, really, is deep thought and learning to control thoughts as they come into your head.” They also added a bit of advice: “For meditation, look online at guided meditations on YouTube.”

Another MySpondylitisTeam member said, “I started seeing a therapist, and she recommended taking a mindfulness class. I’m on week three now, and it has really been helping me change my mindset and love myself and my body more.”

It may take some time to get used to the practice of meditation, and it may not work for everyone. “I laughed my tail off every time I listened to a recording my doctor gave me. It did not work for me!” one MySpondylitisTeam member reported.

Some of the most popular forms of meditation for ankylosing spondylitis include active meditation, mindfulness, and yoga breathing.

Active Meditation

Active meditation means staying present while moving, such as walking, doing chores, or standing in line. The goal is to notice your thoughts and feelings as they arise, then let them go.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction also focuses on the present moment, but it’s usually practiced while sitting or lying still. It can help you manage negative thinking, which adds to the stress of living with a chronic condition like ankylosing spondylitis. Mindfulness can help you acknowledge and accept neck pain instead of worrying about it.

Yoga Breathing

To practice yoga breathing, sit comfortably in a relaxed position and focus on each breath as you inhale and exhale. Try to hold your breath, slowly letting it go: Inhale for four seconds, and exhale for six seconds. Do this for at least two minutes.

Heat Therapy

A simple home remedy for neck pain and stiffness is heat therapy. You can use an electric heating pad, hot water compress, or microwavable heating pad. Warm baths or showers are also good options. Make sure not to overheat compresses or use water that is too hot.

Talk to Your Doctor

If you’re experiencing neck pain from ankylosing spondylitis, don’t wait to bring it up with your doctor. From medication and physical therapy to at-home strategies like heat therapy and mindfulness, there are many options available to help reduce pain and improve mobility. Your healthcare provider can work with you to develop a personalized plan that fits your needs and lifestyle. Managing neck pain may take some trial and error, but you don’t have to do it alone.

Find Your Team

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Did your symptoms of ankylosing spondylitis start as lower back pain and lead to neck pain? How do you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.