Cervical strain is a name given to a group of symptoms involving muscular neck and upper shoulder pain.  The neck musculature is often in spasm, resulting in pain and limitation of motion.  Headache often accompanies cervical strain.  Cervical strain may result from trauma or may occur without any preceding trigger.  The pain originates in the neck area and may radiate to the shoulders or head.  Sleep disturbance and depression may accompany these symptoms.  The neurologic exam is normal, but the muscles of the neck and shoulders are tender to touch.  Range of motion of the neck and shoulders may be limited.  MRI of the cervical spine is useful to exclude bony abnormalities of the spine, tumors and other causes of cervical strain.  Laboratory work is necessary to look for inflammatory arthritis or infections.  The treatment of cervical strain begins with conservative modalities.  These include heat, ice, physical therapy, stretching, TENS and medications.   These medications may include non-steroidal anti-inflammatories, muscle relaxants, narcotics and other adjuvent medication.  Underlying sleep disturbance and depression is treated with tricyclic anti-depressants.  Trigger point injections can be useful to relax muscles that are in spasm and facilitate physical therapy.