Neck pain

The neck is seven small bones stacked between the skull and the shoulders, with discs of cartilage between the bones to absorb shock, a pair of small joints at the back of each level that let the head turn and tilt, muscles that hold the head up all day long, and the spinal cord running down the middle with a nerve leaving at each level, the lower ones for the shoulder, the arm and the hand. Each can hurt, and each of the usual causes announces itself in its own way:

• A strained or stiff neck. A night with the head at an awkward angle, a long stretch at a desk with the neck held forward, a draught, a minor twist while gardening, worry that tightens the muscles at the back of the neck, or nothing anyone can point to: this is the commonest neck pain. The neck is sore and tight, turns less far than it should, and can hurt across into a shoulder or up into the head. Most of it lasts a few weeks at most, and a sudden spasm that locks the neck to one side usually passes in hours or days.
• Wear: cervical spondylosis. Past 40 the discs thin and small spurs of bone grow at the edges of the joints, which is cervical spondylosis, a normal part of ageing that many people have without a symptom. Where it does show, it is neck and shoulder pain or stiffness that comes and goes, with headaches that start at the back of the neck. The section below takes it further.
• A trapped nerve: cervical radiculopathy. A nerve squeezed as it leaves the spine, by a bulging disc or a spur of bone, sends pain from the neck into the shoulder and down one arm, with shooting pains, pins and needles or numbness in part of the hand and sometimes a weak grip; it is usually one-sided, can come on gradually or abruptly, and can wake you at night. A new episode is a same-day matter for your GP or NHS 111, so that a nerve is told from the spinal cord; once that is clear, such episodes often ease over weeks. Which fingers tingle says which nerve is caught; tingling in the hand alone, without any neck pain, is a different question, one our hand and wrist pain guide covers.
• A jolt: whiplash and other injuries. A sudden movement of the head, most often in a car accident, a slip, a fall or a sporting knock, strains the tissues that hold the neck together. The pain, stiffness and headache can take several hours to appear, along with spasms in the shoulders and arms, and most of it is better within two to three months, faster with the neck kept moving than rested. Neck pain after a serious accident, or new trouble walking after any neck injury, is the picture the seek-help list treats as a 999 or A&E emergency, and pins and needles, weakness, an electric-shock feeling, or severe pain that painkillers do not touch after a neck injury need the same day.
• A headache that begins in the neck. Tightened muscles at the back of the neck give a tension headache that spreads over the back of the head, sometimes to behind an eye, and the wear of cervical spondylosis gives headaches of the same starting point. A headache that is new or severe, or one that comes with a stiff neck and a fever, is another matter, and the seek-help list says where it goes.
• The inflammatory neck. Two inflammatory conditions reach the neck and are easily taken for something else. Axial spondyloarthritis inflames the spine, usually from the late teens to the thirties: the back and neck stiffen slowly over months, worst on waking and at night and better with exercise than with rest, sometimes with buttock pain, tiredness or a painful red eye, which is a same-day matter for an eye casualty or urgent eye clinic, as the seek-help list says, and, in a few, the neck can in time stiffen for good. Polymyalgia rheumatica arrives after 50, most often past 65: the shoulders, the neck and often the hips ache and stiffen together over days or a couple of weeks, on both sides, so stiff first thing that lifting the arms above the head is hard, easing as the morning goes on, and it carries the risk of giant cell arteritis alongside. An inflammatory arthritis such as rheumatoid arthritis is among the other causes a doctor keeps in mind.
• Neck pain as part of a wider ache: fibromyalgia. Where the neck is one sore place among many, with pain across the body, poor sleep and tiredness, the question is fibromyalgia rather than the neck itself, and its guide describes it.
• The rare causes, each with a sign of its own. An infection in the neck or its bones is the first thought when neck pain comes with a fever, and meningitis shows itself with a stiff neck, a fever, a very bad headache, eyes that cannot bear bright light or a rash that does not fade when you press it. A fracture follows a serious accident, or a small knock in someone whose bones are thinned, and pressure on the spinal cord brings clumsy hands, weakness in both legs and trouble walking. A cancer that has reached the spine gives night pain, weight loss, and a history of cancer that makes it the first thing to rule out; and a tear in one of the arteries that run through the neck can bring a headache or neck pain and then the signs of a stroke. Each has its place in the seek-help section.

Where the neck hurts, how it began and what comes with it usually say which, before any test is ordered:

• A sore, tight neck after a bad night, a long day at the desk or a twist, that turns less far than usual and hurts into a shoulder, points to strain
• Aching and stiffness in spells past 40, spreading to the shoulders, with headaches that start at the back of the neck, points to cervical spondylosis
• Pain that shoots from the neck down one arm, with pins and needles or numbness in part of the hand, points to a trapped nerve
• Pain, stiffness and headache in the hours after a car accident, a fall or a sporting knock points to whiplash
• Stiffness of the neck and back in someone under 45 that has built over months, is worst on waking and at night and eases with exercise, points to an inflammatory spine
• A neck and both shoulders that have seized up over days in someone over 50, worst first thing and easing over the morning, points to polymyalgia rheumatica
• A neck that is one sore place among many, with tiredness and sleep that leaves you tired, points to fibromyalgia

These are pointers, not a verdict: pain and tingling into an arm happen with a plain strained neck too, and wear and a trapped nerve can go together. The signs of pressure on the spinal cord, of infection and of a serious accident go by the seek-help list first, and pins and needles, numbness or weakness in an arm with neck or arm pain is for the same day, as the list says; the two inflammatory patterns are for a GP, the polymyalgia one after a week of it; the rest can start at home.

Cervical spondylosis is the neck's share of the wear of the years. With time the discs between the bones lose height and the small joints at the back of the neck roughen, and spurs of new bone grow at their edges, which an X-ray shows in almost everyone at some point, somewhere in the spine. Much of it never hurts. Where it does, the neck and shoulders ache and stiffen in spells that come and go, the neck turns less far, a grating or clicking can be heard as the head moves, which sounds worse than it is, and headaches begin at the back of the neck. It is likelier after 40, after an earlier neck injury, and where it runs in the family, and it is the neck's form of osteoarthritis, which has its own guide. It is not to be mistaken for an inflamed spine: spondylosis is wear, and the inflammation of axial spondyloarthritis behaves differently and is treated differently.

The trouble comes when the changed bones and discs press on what runs past them. A disc that bulges or a spur that grows into the gap where a nerve leaves the spine squeezes that nerve: the arm pain, pins and needles, numbness and weakness of cervical radiculopathy, usually on one side, and often settling over weeks. Far less often the narrowed canal presses on the spinal cord itself, which is cervical myelopathy: the hands become clumsy, buttons and keys turn into a struggle, the legs weaken and walking changes, and the bladder or bowels can be affected. The nerve can be watched once it is known to be the nerve and not the cord; the cord cannot wait, and its signs are a 999 or A&E emergency in the list below, because they can get worse and treatment protects what is left. A pinched artery in the neck can, occasionally, bring dizziness or a blackout on looking up or turning the head; a blackout with any of the signs of a stroke, or one from which the person cannot be woken, is a 999 or A&E emergency, and short of those, either is a same-day matter for your GP or NHS 111, as the seek-help list says.

What helps is what helps most neck pain. Gentle neck exercises done every day, the posture at the desk and in bed looked at, and paracetamol or ibuprofen for the bad spells are the mainstay; a pharmacist can suggest something stronger where those are not enough, and a short course of a muscle relaxant is sometimes prescribed for a spell that has dragged on. Physiotherapy comes in where a few weeks of self-care have not settled it. For a nerve that stays irritated, a medicine that quietens nerve pain, gabapentin or pregabalin, can be tried for some weeks, and a low dose of amitriptyline can relax the muscles and help sleep. Surgery is considered only where a nerve or the cord is being squeezed and the weakness or pain will not relent, and it is not always a cure: what it can do is stop things getting worse.

Most neck pain is diagnosed by asking and examining, and needs no test at all. What matters is how it began, whether it followed a jolt or a particular activity, whether the pain is a shooting one or an ache, what makes it better or worse, where it spreads, how you sleep with it, and what else is going on: a fever, weight loss, an earlier cancer, or an inflammatory condition already diagnosed. The examination looks at how the neck moves and where it is tender, feels for swollen glands, and tests the strength, feeling and reflexes of the arms and legs, with a look at how you walk, since a changed walk is one of the signs of pressure on the spinal cord.

Point-of-care ultrasound is part of the consultation with Dr Borukhson, and in the neck its place is a small one. The neck itself is a job for the examination and, where something remains unclear, for a scan; ultrasound's value is beside the neck: it is among the tests used when polymyalgia rheumatica is the question, and a scan of the arteries at the temples is one of the tests that find giant cell arteritis when it is suspected after 50. The scan itself is described on our ultrasound clinic page.

An X-ray of the neck is not routine, since wear of that kind is so common that it seldom explains the pain. An MRI scan is asked for when the examination leaves a question: a squeezed nerve that is not improving after several weeks of treatment, or weakness that is spreading, a question of the spinal cord, or a possible infection; after an injury, an X-ray or a scan shows whether a bone is broken. Blood tests come in where the pattern is inflammatory, looking for the inflammation of polymyalgia rheumatica or the markers that go with an inflammatory spine, and a referral to a rheumatologist follows where an inflammatory spine is likely.

Because the treatment differs with the cause, the assessment comes first:

• A strained neck is treated by keeping it moving: gentle exercises, paracetamol or ibuprofen as tablets or a gel, heat or an ice pack, and a return to your usual activities as the pain allows; a collar is not advised, since a neck held still stiffens.
• Cervical spondylosis is managed as its section describes: exercises, posture, painkillers, physiotherapy, and a nerve-pain medicine where a nerve stays irritated.
• A trapped nerve often eases over weeks with the same measures; gabapentin or pregabalin can be added for the nerve pain, and a nerve that is not recovering after several weeks, or a hand or arm that is weakening, which is for your GP or NHS 111 the same day, as the seek-help section says, is scanned and, where the weakness persists, considered for surgery to free it.
• Whiplash is treated by carrying on: painkillers, everyday activities within the pain, no collar and no long rests, with a GP after a week if it is not improving; a GP can prescribe a stronger painkiller such as codeine for a bad spell, and physiotherapy or a pain clinic where it is slow to settle.
• The inflammatory spine is treated as our axial spondyloarthritis guide sets out, with exercise and physiotherapy, anti-inflammatory tablets, and the biologic medicines where they are needed, and the sooner it is recognised the sooner the treatments that work can start.
• Polymyalgia rheumatica is treated with the steroid tablet prednisolone, tapered over a year or two, as its guide describes, with the signs of giant cell arteritis watched for throughout.
• A tension headache eases with the neck: relaxation, posture and the same painkillers, with a GP's review where headaches come several times a week.

An injection is the exception in the neck: a steroid injection into the small joints at the back of the neck is offered to a small minority with persistent pain, guided by imaging so that the needle is placed exactly. You and Dr Borukhson settle the plan together.

For a neck that has begun to hurt, or is having one of its spells:

• Keep it moving: gentle turning and tilting through the neck's range every day, and your usual activities as far as the pain allows, since a neck that is rested for days stiffens and weakens; a day or two of taking it easy at the start is enough
• Do not wear a neck collar unless a doctor has asked you to, and do not drive or cycle while you cannot turn your neck
• Heat or cold, whichever eases it: frozen peas in a tea towel for five minutes, three times a day, or a hot water bottle in a tea towel for twenty minutes, two or three times a day, never straight onto the skin
• Painkillers from the pharmacy: paracetamol, or ibuprofen as a gel rubbed into the neck or, for a short course and not for everyone, as tablets, taken before the pain builds rather than after. With the gel on, do not smoke or get close to a naked flame, since clothes in contact with ibuprofen gel burn more easily
• Sleep with a low, firm pillow, so that your head is level with the rest of your body, on a firm mattress, not on your front, and without twisting your neck in bed
• Sit upright at the desk with the screen at eye height, roll the shoulders back gently and bring the neck back, get up and move every so often, and use a headset rather than holding the phone with your shoulder
• Give the muscles at the back of the neck a chance to let go when worry or stress is tightening them: a warm bath, a walk, or whatever helps you unwind

Almost every sore neck begins with self-care and, if it drags on, a routine appointment. A few pictures are different and should not wait: pressure on the spinal cord or a nerve, a stroke that starts in the neck's arteries, an infection in or around the neck or one that has become sepsis, a neck that may be broken, a heart attack felt in the back, and, in someone past 50 whose neck and shoulders have stiffened together, the signs of giant cell arteritis.

Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.

• New difficulty walking, weakness or numbness in both legs, a loss of control of your bladder or bowels, or hands that have suddenly become clumsy or weak, since these can mean pressure on the spinal cord in the neck, which has to be relieved without delay
• Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
• A stiff neck with a fever, a very bad headache, eyes that cannot bear bright light, or a rash that does not fade when you press it, since meningitis can begin this way, and, with a fever or feeling unwell, skin, lips or tongue turning blue, grey, pale or blotchy can be a sign of sepsis; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet; a red, painful eye that light hurts, with none of the other signs in this line, is for an eye casualty or urgent eye clinic the same day, as the second list says
• Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and the arteries that run up through the neck to the brain can be where the trouble starts; in someone over 50 whose neck and shoulders have stiffened, sight that faded and came back on its own, with none of the other signs, belongs to the second list, for an eye casualty or urgent eye clinic the same day
• An eye that suddenly and completely loses its sight
• Lips, mouth, throat or tongue that suddenly swell, a throat that feels tight, very fast breathing or a struggle to breathe or to swallow, skin, tongue or lips turning blue, grey or pale (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet), becoming suddenly very confused, drowsy or dizzy, or fainting and not being able to be woken, since this can be a severe allergic reaction, anaphylaxis, which can follow a dose of any medicine
• Neck pain that began after a serious accident, such as a car crash or a fall from a height, since the neck may be broken and has to be checked before anything else

Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:

• Severe neck pain that started suddenly or is getting worse quickly, severe pain after a neck injury that painkillers do not touch, or pain after a small knock or fall if you have osteoporosis, take steroid tablets or have a spine stiffened by axial spondyloarthritis, since a fracture or another serious cause has to be found the same day
• Heaviness, weakness, numbness or pins and needles in an arm, a hand or a leg, with pain in the neck or the arm, or an electric-shock feeling that shoots down your back or into your limbs when you bend your neck, since a nerve or the spinal cord can be under pressure
• Pain between your shoulder blades with the neck pain, since pain there can come from somewhere other than the neck; with pain in the chest as well, or with sweating, feeling sick or breathlessness, it is a 999 or A&E emergency, since a heart attack can be felt in the back and the neck; call 999 and do not drive yourself to A&E
• Dizziness that comes with turning the head or looking up, or a blackout, since an artery in the neck can be squeezed, and a blackout with any of the stroke signs above, or one from which the person cannot be woken, is a 999 or A&E emergency
• A fever, feeling shivery, or feeling generally unwell, together with the neck pain, since an infection in or around the spine has to be found the same day; with shaking, confusion, rapid breathing, skin, lips or tongue turning blue, grey, pale or blotchy, or feeling dramatically worse over hours, which can be sepsis, or with a stiff neck, a very bad headache, eyes that cannot bear bright light or a rash that does not fade when you press it (on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet), it is a 999 or A&E emergency, the pictures above
• A new headache, a scalp that is tender, or pain in the jaw or tongue when chewing, since past 50 these can be giant cell arteritis, which is treated as soon as it is suspected to protect the sight, and a headache that is new, or severe without having come on suddenly, with neck pain needs checking the same day at any age, a sudden severe one being among the stroke signs above; our polymyalgia rheumatica and giant cell arteritis guides explain how the two go together
• In someone over 50 whose neck and shoulders have stiffened, sight that has blurred, doubled or dimmed, that is lost in part, or that faded and came back, which needs an eye casualty or urgent eye clinic the same day, since these can be the signs that giant cell arteritis is threatening the eye
• A new red, painful eye, or sight that has blurred, dimmed or changed, which needs an eye casualty or urgent eye clinic the same day, as does an eye that light hurts, since axial spondyloarthritis, which this guide names among the inflammatory causes, can set off inflammation inside the eye; the signs are in our uveitis guide

See a GP if the pain or stiffness has not gone after a few weeks, or after a week if it followed a jolt and is not improving, if painkillers have not helped, if you have a cold arm with it, or if you are worried about it; and see one without waiting for weeks if pain at night is so bad that nothing you do eases it, if you have lost weight without trying, or if you have had cancer, since those are the patterns that need a closer look. See one after a week of it, not later, if you are over 50 and your neck and both shoulders, or your hips too, have stiffened together over days or a couple of weeks, worst on waking and easing as the morning goes on, since polymyalgia rheumatica is treated as soon as it is recognised. A neck and back that have stiffened over months in someone under 45, worst on waking and at night and better for exercise, are for a GP too, and the question is an inflammatory spine, which our axial spondyloarthritis guide takes up. You do not need a referral to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible. If you cannot tell how urgent something is, asking is never a mistake.

Most sore necks do not need a rheumatologist. What an assessment offers is for the necks that do not behave: the arm pain and tingling that need a scan and a plan, and the wear that has begun to press on a nerve or, short of the 999 or A&E signs above, on the cord. It is for the young spine whose stiffness eases with exercise and has been called strain for longer than it should, and for the older neck and shoulders that stiffened as one in a fortnight and are polymyalgia rheumatica, which answers to steroid tablets within a couple of weeks once named, with giant cell arteritis watched for beside it. An assessment separates strain from these, arranges the right test where one is needed and none where it is not, and starts the right treatment early where it matters. If your neck pain is persistent, has changed, or comes with anything more than pain and stiffness, that visit can get to the cause and set out what to do.

Is my neck pain cervical spondylosis?

If you are past 40 and the neck aches and stiffens in spells, with pain that spreads into the shoulders and a headache that starts at the back of the neck, it may well be. Cervical spondylosis is the ordinary ageing of the neck: the discs lose height and the joints grow small spurs of bone at their edges. Wear of this kind is all but universal in time, and much of it never hurts, so what an X-ray shows is rarely the whole explanation for a sore neck. It is managed rather than cured: gentle neck exercises, attention to posture, painkillers from the pharmacy for the bad spells, and physiotherapy where a spell drags on. The exceptions are the spells that squeeze a nerve or the spinal cord, which bring pins and needles, weakness or clumsiness and are dealt with as the seek-help section says.

Why do I have pins and needles down my arm?

Often because a nerve is being pinched where it leaves the neck, by a bulging disc or a bony spur, which doctors call cervical radiculopathy, though tingling into an arm happens with a plain strained neck too. It gives a shooting pain from the neck into one shoulder and arm, tingling or numbness in part of the hand, sometimes a weak grip, and it can be bad enough to disturb sleep. The fingers that tingle point to the level: thumb and index finger at one, the middle finger at the next, the ring and little fingers at the one below. Such episodes often ease over a few weeks provided the neck keeps moving, and a medicine that calms an irritated nerve can be added. Pins and needles or numbness in an arm or hand together with neck or arm pain should be seen the same day, by your GP or through NHS 111, and so should heaviness or weakness in an arm, hand or leg with it, because the trouble can grow the longer a nerve or the cord stays under pressure; hands that have suddenly turned clumsy or weak, or new trouble walking, are a 999 or A&E emergency, as the seek-help section says. Tingling in the hand alone, with no neck pain, is another matter, which our hand and wrist pain guide takes up, a nerve under pressure at the wrist among its causes.

Could my neck pain be inflammatory rather than wear?

Two inflammatory necks stand apart from the rest. In someone under 45, a neck and back that have stiffened over months rather than days, at their worst on waking and at night and freer after exercise than after rest, can be axial spondyloarthritis, an inflammatory arthritis of the spine that often goes unrecognised for some time because it is taken for ordinary back trouble; it is for a GP and a rheumatologist's assessment rather than months more of waiting. In someone over 50, a neck and both shoulders, and often the hips, that have seized up together inside days or a couple of weeks, so stiff first thing that raising the arms is a struggle, and easing as the morning goes on, is the pattern of polymyalgia rheumatica: a GP question after a week of it, not later, since it is treated with a steroid tablet as soon as it is recognised. That second pattern carries a companion to watch for, giant cell arteritis, which shows itself as a headache that is new (a sudden severe one being among the signs of a stroke, a 999 or A&E emergency), a scalp sore to the touch, or an ache in the jaw on chewing, each a same-day matter for your GP or NHS 111, and as any change in your sight, which needs an eye casualty or urgent eye clinic the same day; sight that goes suddenly and completely is a 999 or A&E emergency, as the seek-help section says.

Will I need a scan of my neck?

Usually not. The usual causes are picked out from what you say and from an examination of the neck, the shoulders and the nerves that serve the arms and legs, and an X-ray of the neck seldom changes the plan, because some wear shows somewhere in nearly every spine sooner or later. A scan earns its place when the picture asks a question the examination cannot answer: an MRI where a nerve is being squeezed and is not recovering after several weeks, where weakness or clumsiness raises the question of the spinal cord, or where an infection is possible. Blood tests join in when the pattern is inflammatory, for polymyalgia rheumatica or an inflammatory spine, and an ultrasound scan of the arteries at the temples is part of finding giant cell arteritis when that is the question.

Should I wear a collar and rest my neck?

No to the collar, and only briefly to the rest. A soft collar keeps the neck still, and a neck that is kept still stiffens and recovers more slowly, so it is not advised unless a doctor has asked for one for a more serious or complex problem. A day or two of taking it easy is reasonable when the pain is at its worst, and after that the neck does better kept moving: gentle turning and tilting through its range every day, your usual activities as far as the pain allows, and the desk, the pillow and the driving position looked at. Heat or an ice pack, and paracetamol or ibuprofen, take the edge off while it settles. One caution: do not drive or cycle while you cannot turn your neck.

When should I see someone about my neck?

New difficulty walking, weakness or numbness in both legs, a loss of bladder or bowel control, hands that have suddenly become clumsy or weak, the signs of a stroke, a sudden severe headache among them (even if they stop after a short time), a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours, or, with a fever or feeling unwell, skin, lips or tongue turning blue, grey, pale or blotchy, which can be sepsis, a stiff neck with a fever, a very bad headache or eyes that cannot bear bright light, or with a rash that does not fade when you press it (on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet), or neck pain after a serious accident, or a blackout from which the person cannot be woken, or the signs of a severe allergic reaction to a medicine, which the first list under When to seek help sets out: any of these is a 999 or A&E emergency. Call 999 and do not drive yourself to A&E. Your GP is the right first call for pain or stiffness that has not gone after a few weeks, or, after a jolt, when a week has passed without improvement, for painkillers that are not helping, for a cold arm, or when you are worried; and, without waiting for weeks, for night pain so bad that nothing you do eases it, weight you have lost without trying, or a history of cancer. A neck and both shoulders that have stiffened as one in someone over 50 is a GP question after a week of it, not later, and a neck and back that have stiffened over months in someone under 45, easier for exercise, is one for a GP and then a rheumatologist. Same-day matters for your GP or NHS 111 are severe pain that came on suddenly or is worsening fast, severe pain after a neck injury that painkillers do not touch, and pain after a small knock or fall in someone with osteoporosis, on steroid tablets or with a spine stiffened by axial spondyloarthritis. So are pins and needles, numbness, heaviness or weakness in an arm, hand or leg with pain in the neck or the arm; an electric-shock feeling down the back when you bend your neck; dizziness on turning the head, or a blackout; pain between the shoulder blades, unless chest pain, sweating, feeling sick or breathlessness comes with it, which makes it a 999 or A&E emergency, since it can be a heart attack; and a fever with the neck pain. A headache that is new, or severe without having come on suddenly, with the neck pain is a same-day question for your GP or NHS 111 at any age; past 50, a sore scalp or an aching jaw on chewing needs the same day too, from your GP or NHS 111, since giant cell arteritis is then the question. A change in sight, or a new red, painful eye, needs an eye casualty or urgent eye clinic the same day, and sight lost all at once, even if it came back, is a 999 or A&E emergency; the one exception is in someone over 50 whose neck and shoulders have stiffened, where sight that faded and came back on its own, with none of the other signs of a stroke, needs an eye casualty or urgent eye clinic the same day, as the seek-help section says. Being seen here needs no referral; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible.