A stiff neck from a draught or after sleeping, explained by a doctor

Autumn brings a complaint I hear at my practice almost every day. You wake up in the morning and can't turn your head, or you spent the evening next to an open window and the next day your neck is locked to one side and hurts with every movement. Here I'll explain what a stiff neck is, when it becomes urgent, what helps at home and where Bowen therapy comes in.

What a stiff neck actually is

In most cases it is a muscle spasm. The neck muscles tighten and refuse to relax, so every attempt to turn your head hurts, and your body holds you in a crooked position of its own accord to protect the area. Doctors call it acute torticollis. It looks alarming, but it is benign and usually goes away by itself. From what I see at my practice, a neck that stiffened during sleep or from a draught loosens up within a few days for most people.

The NHS is Britain's public health service, and on its page about neck pain it says that most neck pain gets better within a few weeks, and among the most common causes it lists sleeping with the neck stuck in an awkward position and sitting hunched at a desk for hours on end.

When a stiff neck is an emergency

Before any remedy, you need to know when a stiff neck is no longer just a tight muscle. A stiff neck is also one of the signs of meningitis, an infection of the membranes that surround the brain and spinal cord, which can be life-threatening if it isn't treated quickly. The symptoms come on suddenly and at first they can look like flu.

Call 112 (the EU emergency number) or go straight to A&E if any of these appear:

• a high temperature, chills, very cold hands and feet
• a very bad headache that keeps getting worse
• a stiff neck together with being unable to bear bright light
• confusion, slurred speech or drowsiness that makes it hard to wake the person
• spots or a rash that doesn't fade when you press a glass against it
• a seizure, the first one in your life

There is one more case where you don't wait at all. If the pain started after a blow, a fall or an accident, a doctor needs to see your neck before you massage it or put heat on it. With children the threshold is even lower. A child with a fever who holds their neck stiffly, has an unusual high-pitched cry, won't eat, or is floppy and hard to wake goes to A&E, not to home remedies. Tingling or numbness in an arm, or an arm that feels cold, also needs a check-up even if you have no temperature.

Can a draught really give you a stiff neck?

“I sat in a draught” is the explanation I hear most often. I looked for studies that had tested draughts directly and I didn't find a single one. There are studies on cold, though.

The largest of those I read came out in 2022 in the journal Ergonomics and included 12,627 people from northern Sweden aged between 18 and 70. Those who said they worked a lot in the cold had neck pain more often, with roughly a 36% higher chance than the others, even after the researchers took age, physical workload, smoking and stress into account.

This is an association and it doesn't prove cause. The study asked about cold at work, not about the open window on the train. It is plausible that cold makes a muscle tenser and less supple, but going from there to “a 5-minute draught locked my neck” is a step the data don't take. In practice I see that the position you were in, and how long you stayed still in it, matter just as much.

A stiff neck after sleeping

Here the cause is usually more mundane. You slept for hours with your head twisted or propped too high on the pillow, and the muscles spent the whole night stretched on one side and squeezed on the other. The NHS gives a few simple tips for the night. Your head should be level with the rest of your body, on a low, firm pillow and a firm mattress, without sleeping on your front and without twisting your neck in bed.

What helps at home

The good news is that the things that help are few and cheap. I took them from the NHS recommendations rather than from household habits:

• Move your neck gently, within the limits of the pain. A neck collar isn't a good idea unless a doctor fitted it, because the neck recovers better when it moves.
• Heat, for example a hot water bottle wrapped in a towel, for 20 minutes 2 or 3 times a day. If cold makes you feel better, a bag of frozen vegetables in a towel, for 5 minutes 3 times a day.
• An ordinary painkiller or a gel for muscle pain, once you've asked your pharmacist or doctor what suits your other treatments.
• No driving and no cycling while you can't turn your head to check around you.
• Frequent breaks if you work at a desk, because a neck held in the same position for a long time stiffens up again.

I have to be honest about heat, because the evidence is thin. A systematic review published in 2026 in the Journal of Pain Research searched for studies on the subject and found only 2, with 67 participants in total, both of poor methodological quality. The authors say the evidence isn't enough either to recommend it or to reject it, but that it remains an option for home care, since no serious side effects are expected. It is a handy aid and not a proven treatment.

When to see your family doctor

Torticollis in babies is something else

When parents search for “stiff neck in children” they often end up on a completely different subject. Congenital muscular torticollis appears shortly after birth and has nothing to do with draughts or pillows. A muscle at the side of the neck is shorter on one side, so the baby keeps the head tilted towards one shoulder and turned towards the other. The guideline published in 2018 by the American academy of paediatric physical therapy recommends that these children be referred to physiotherapy as soon as the asymmetry is noticed. If you see it in your child, the first stop is the paediatrician.

Where Bowen therapy comes in

Bowen doesn't replace a medical consultation, and it isn't done on a neck with any of the signs above.

Bowen therapy is a gentle manual technique, with short moves over the muscles and fascia separated by pauses in which nobody touches you. There are no manipulations, and the neck is never forcibly twisted, which matters for a muscle that is already in spasm.

The evidence is limited and I'll tell you exactly what it is. A systematic review from 2011 found 15 studies on Bowen, including just one randomised trial and 7 case reports, and the authors wrote that the scientific evidence was not well documented. For the neck there is a study published in 2023 in Hong Kong, in which 90 patients with myofascial neck pain received either 8 Bowen sessions over 12 weeks or their usual treatment. Those who had Bowen did better on pressure pain threshold, neck mobility and quality of life. Their pain had lasted more than 6 weeks, however, so this wasn't a neck that had stiffened up yesterday, and the study had no sham treatment group, so part of the difference may come simply from the fact that someone was looking after them.

So where does it make sense? If your neck hasn't loosened up after a few days or keeps stiffening in the same place again and again, we can talk about it at my practice, because I also use Bowen on a neck that stiffened only recently, not just on long-standing pain. First I check what's going on as a doctor, and then we work gently on the tension that's left. If nothing changes after 2 or 3 sessions, I'll tell you so openly.

I've gone through the studies in detail in the article on back and neck pain, and I wrote about what cold does to the muscles in why your back hurts when the weather changes. The fees page shows what a Bowen therapy session costs.

This article is for information and does not replace a medical consultation. Do not stop or change a prescribed treatment without talking to the doctor who prescribed it.

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