Your neck has been pulling for days and one evening, in the dark, you feel your heart racing. The thought comes by itself: it must be the neck.
Before getting to that explanation, which is the most read part of this article and also the riskiest, we have to go through something else. And it cannot wait.
First of all: when palpitations are an emergency
Call 112 or go to the emergency department now, without finishing reading, if the palpitations come with any of these:
- chest pain, heaviness or tightness, especially if it radiates to the arm, shoulder, jaw or back;
- shortness of breath that does not pass when you sit down;
- sudden cold sweats, nausea, a feeling of intense unwellness;
- fainting, or the clear sensation that you are about to faint;
- a very fast heartbeat that does not slow down, or that starts and stops suddenly like a switch.
None of these pictures is explained by the neck, and none of them should be waited out to see if it passes.
Then there is the more common case, that of people who have none of those signs. Only one rule applies, and it is simple: new or recurring palpitations should be assessed by a doctor with an electrocardiogram. They should not be explained away as neck problems, neither by you nor by me.
This is not a defensive precaution. A review on the management of palpitations in general practice is explicit: anyone presenting with this symptom as the main complaint deserves a history, a physical examination and an electrocardiogram, and often this is enough to guide the diagnosis. If the picture requires it, a Holter monitor, blood tests and a cardiology consultation are added.
Why symptoms alone are not enough to decide
Here is the data point that should take the idea of self-diagnosis off the table. In an observational study of 338 adults who came to the emergency department with suspected acute coronary syndrome, panic disorder was diagnosed in 5.6% of cases.
The authors compared the symptoms reported by the two groups: apart from a slight difference in describing the pain as heavy, all the other symptoms were overlapping.
The conclusion of the study is that the signs and symptoms collected routinely in the assessment of chest pain do not make it possible to distinguish those with panic disorder from those without. Translated: the sensation is not a test. If you have convinced yourself that it is anxiety, or that it is the neck, because the palpitations seem to you to be of a certain kind, you are relying on a criterion that does not work in the emergency department.
The case of atrial fibrillation
There is a specific reason why it is worth being insistent on this point. Atrial fibrillation shows up with palpitations, shortness of breath, chest pain, tiredness, a feeling of fainting and reduced tolerance of exertion: exactly the group of symptoms that an adult with a sore neck may attribute to tension or stress.
And there is more: according to a review published in JAMA in 2025, 10-40% of people with atrial fibrillation have no symptoms at all. If it is possible to have it without noticing, it is obvious that feeling only a little agitated is not enough to rule it out.
The practical difference is big. Atrial fibrillation increases the risk of stroke, and in people with an estimated risk equal to or above 2% a year, anticoagulant therapy reduces that risk by 60-80% compared with placebo. It is a diagnosis made with a tracing and one that changes a person's clinical history. Calling it neck problems does not make it harmless: it only leaves it untreated.
I add an older data point but a useful one for proportions. In a prospective study of 190 people who came consecutively to a university centre complaining of palpitations, the cause turned out to be cardiac in 43% of cases and psychiatric in 31%, while in 16% it remained unknown.
It should be read for what it is: it concerns people who had gone to a doctor precisely for that symptom, not the general population, and it dates from 1996. But the message holds. Among those who go to be seen for palpitations, the heart is involved in a far from negligible share.
Two different words used as synonyms
A useful clarification, if only for talking to the doctor. Tachycardia means a heart rate above 100 beats per minute, measured. Palpitation is the sensation of being aware of your own heartbeat, whether fast, strong or irregular.
They are two different things, and almost always whoever searches for "neck and tachycardia" is talking about the second. Saying it precisely to the doctor saves them time.
What the research really says about the link between neck problems and tachycardia
Now the question of the article. And the honest answer, before elaborating it: a direct causal relationship between cervical osteoarthritis or neck pain and tachycardia has not been demonstrated. It is not a cautious position out of superstition, it is what comes out when you go and check.
The most severe test this idea has received comes from surgery. A review with meta-analysis gathered 27 studies on patients operated with cervical decompression, looking at what became of the so-called atypical symptoms of cervical spondylosis: headache, nausea, dizziness, tinnitus, blurred vision, stomach complaints, palpitations and high blood pressure.
The result is instructive. After the operation, cervicogenic headache, tinnitus, dizziness and nausea improved in a statistically significant way. Palpitations did not improve significantly, nor did high blood pressure, blurred vision or memory disturbances.
Let's pause on what this means. If the mechanical problem of the neck were the cause of palpitations, removing that problem should have removed the symptom too, as happened for dizziness and tinnitus. It did not go that way. It is the strongest clue we have, and it goes in the opposite direction to what the forums tell.
Then there is the strand on heart rate variability (HRV), an indirect index of how the autonomic nervous system governs the heart. A systematic review on adults with chronic musculoskeletal pain, including neck pain and whiplash, found in general a higher sympathetic and lower parasympathetic modulation compared with healthy controls.
The same authors write, however, that the 20 included studies were of low to moderate quality, so heterogeneous that they did not even allow a meta-analysis, and that no definitive conclusions can be drawn.
I also add something that data point does not say: a shift in HRV measured at rest is not a tachycardia, and it does not say who pushed first, the pain on the autonomic system or the autonomic system on the pain.
The theories in circulation, one by one
It is worth taking them apart in detail, because they are the sources from which the belief that the neck makes the heart speed up arises. There are four, and they hold up very differently.
Barré-Liéou syndrome
It is the historical reference that always appears in these discussions: a posterior cervical syndrome described in the 1920s, which groups tinnitus, dizziness, neck and head pain and various vague complaints, attributed to ischaemia caused by compression of the cervical sympathetic nerves.
The problem is that today that entity is considered outdated. A review published in the Journal of Laryngology and Otology uses it precisely as an example of a discredited diagnosis kept alive by lists of eponyms: the original description puts together unrelated complaints, and the proposed causal mechanism has been disproved.
The authors also note that references to the syndrome keep increasing on the internet, particularly on alternative medicine and law firm websites.
So, if you find Barré-Liéou cited as proof that the neck causes palpitations, you are reading a historical label, not a demonstrated mechanism.
Irritation of the cervical sympathetic
This is the modern version of the same idea, and on paper it is plausible: the cervical spine is close to structures of the sympathetic nervous system, the sympathetic also regulates the heart, so an irritation of the neck could speed up the heartbeat. Plausible, however, does not mean demonstrated, and someone has tried to measure it.
In a human physiology study, researchers directly recorded muscle sympathetic activity while the subjects turned their head to the side, a movement that activates the neck receptors without stimulating the vestibular system.
Sympathetic activity did not change: 13 bursts per minute before and 13 during. Heart rate went from 64 to 66 beats per minute, a difference that did not reach statistical significance.
When instead the head was flexed forward and down, involving the vestibular system, sympathetic activity rose by 79%. The authors conclude that the effect comes from the vestibular system, not from the neck receptors. These are small numbers, five or six subjects per condition, and they do not close the question forever. But they are the only direct measurement we have, and it does not support the theory.
The baroreceptor reflex and the neck mechanoreceptors
Here there is an irony worth telling. A reflex that starts from the neck and acts on the heart really exists, but it goes in the opposite direction to the one being sought.
The arterial baroreceptors are located in the carotid sinus, that is, in the neck. When they are too sensitive it is called carotid sinus syndrome, which is a recognised and often undiagnosed cause of fainting in the elderly, and it is assessed with carotid sinus massage. The outcome, in short, is losing consciousness: not a racing heart.
As for the cervical mechanoreceptors, they exist and are numerous. The cervical spine has highly developed proprioceptive receptors, whose signals are integrated with the visual and vestibular ones. This explains well how the neck can generate disorientation and unsteadiness. It does not explain the rhythm of the heart, which is not part of that circuit.
Cervicogenic vertigo, and what it teaches
Dizziness from the neck is the case in which the link between neck and symptom holds up best, and for this reason it is a good test bench for how such a hypothesis is validated.
Even here, however, a 2022 narrative review is clear: the diagnosis of cervicogenic vertigo is made on the basis of clinical features, diagnostic tests and the exclusion of other possible causes of vertigo. The cervical torsion test seems the best method available, and the treatment resembles that of neck pain.
If even the symptom with the most solid link remains a diagnosis of exclusion, which requires having first ruled out the rest, it is not clear by what logic palpitations should be attributed to the neck without having ruled out anything.
It is worth noting that the same caution is needed for the other so-called atypical symptoms: some, like dizziness and headache, hold up; others, like palpitations and high blood pressure, did not withstand verification. Not all symptoms attributed to the neck are the same.
What can really link the two things
Having said all this, the fact that the two symptoms occur together is real, and the people who tell of it are not making it up. There are mechanisms that relate them without the neck needing to command the heart.
Pain raises heart rate. A systematic review on the effects of experimental pain in healthy adults found an increase in sympathetic-baroreceptor activity and a reduction in vagal-parasympathetic activity.
Pain, in other words, shifts the autonomic balance towards the accelerator. It is not the neck speaking to the heart: it is pain as pain, wherever it comes from.
Anxiety is the most solid candidate. Prolonged stress, anxiety, poor social support and depression are recognised risk factors for neck pain. And anxiety disorders are, as we have seen, one of the most frequent causes of palpitations among those who get examined.
No arrow between the two symptoms is needed: a third thing that sets both off is enough, and it is the most economical explanation. We talk about it in depth in the article on neck problems from stress.
High breathing is common to both. Dysfunctional breathing refers to altered breathing patterns that produce air hunger and other symptoms in the absence of, or in excess of, a respiratory or cardiac disease that would justify them.
Among the pictures described in the literature are hyperventilation syndrome and chest-dominant breathing, the kind that uses the upper chest and neck instead of the diaphragm.
The point is that this way of breathing keeps the scalenes, sternocleidomastoids and the muscles of the upper chest wall under continuous load, that is, the same ones that hurt when the neck pulls. And it is the same thing that makes it hard to tell neck tension from difficulty breathing deeply.
Chest tension confuses the cards. Those muscles, when contracted, give sensations of constriction or weight on the sternum that are read as cardiac. Here the neck really is involved, but with the sensation, not with the rhythm. Everything written above remains valid: the sensation is not a test, and telling it apart from a cardiac cause is not your job.
The arrow might point the other way. Extrasystoles and irregular beats are very common even in perfectly healthy people. What changes, when you are worried about a symptom, is how much you notice them. A sore neck puts you on alert about your body, the alert makes you monitor your heartbeat, monitoring it makes you perceive it.
Drugs and substances: the item nobody checks
This part is missing from almost all articles on the subject, and it is one of the most concrete, because it is the only one you can act on straight away with the doctor.
Beta-2 agonist bronchodilators, those in inhalers for asthma and COPD, raise the heart rate in a measurable way.
A meta-analysis of randomised controlled trials found that a single dose increases heart rate by 9.12 beats per minute compared with placebo, and that in prolonged treatments the risk of sinus tachycardia was more than tripled. If you have recently started an inhaler, this is information to bring to the doctor.
The thyroid. A dose-response meta-analysis on over 649,000 people found an increased risk of atrial fibrillation in both clinical and subclinical hyperthyroidism.
That is why the thyroid is almost always among the blood tests for palpitations, and why an excessive dose of levothyroxine should be reviewed with whoever prescribed it. Together with the thyroid, haemoglobin and electrolytes are usually checked too: none of these can be seen by palpating the neck.
On coffee, the truth is less clear-cut than you have been told. In a study of 1,388 adults monitored with 24-hour Holter, an elderly cohort with an average age of 72, habitual consumption of coffee, tea and chocolate was not associated with a greater number of extrasystoles, either atrial or ventricular.
A later randomised trial on 100 younger adults, 39 years old on average, with continuous electrocardiogram for 14 days, confirmed that on coffee days atrial extrasystoles did not increase significantly. It did however find more ventricular extrasystoles, 154 versus 102 a day, and about 36 minutes less sleep per night.
So: cutting coffee on principle is not supported. Reducing it makes sense if you notice a relationship yourself, or if it is shortening your sleep, which is after all the route by which coffee really ends up worsening anxiety and palpitations.
An example of how not to be fooled even the other way round. Over-the-counter nasal decongestants have a reputation for making the heart pound.
A 2025 Cochrane review of five randomised trials found that they may have little or no effect on blood pressure and heart rate, with very low certainty evidence. It is not a green light: it is a reminder that even presumed culprits should not be taken for granted.
How to tell whether the neck is involved in your case
Once cardiac causes have been ruled out with the doctor, you can do some serious observation. Do not trust memory: keep a diary for two or three weeks, noting the date and time of the episodes, how long they last, what you were doing, and in parallel how the neck was that day from 0 to 10.
Also note three things that are usually forgotten: how many hours you slept, how many coffees you drank and whether you started or changed a medication. These are the variables that explain more episodes than posture does.
Then look at the data with a critical eye. Do the palpitations appear when you move or load the neck in a specific way, or do they arrive with the neck still, in the evening, in front of a deadline? In the weeks when the neck is better, do the palpitations really decrease, or do they stay identical? Do they also appear on days when the neck is fine?
And here comes the part nobody likes to write. If after weeks of good work on the neck the neck pain has gone down and the palpitations have stayed exactly the same, the answer has arrived: it was not the neck.
It is not a failure of the pathway, it is information. It means the cause must be looked for elsewhere: in anxiety, in sleep, in a medication or in a cardiac cause to be re-examined. Insisting on the neck hoping the heart will follow is only wasted time, and in the worst case it is time taken away from a diagnosis.
What makes sense to do, sticking to what is documented
First a premise: the exercises and advice that follow are general indications, they come after the medical assessment and do not replace it. If you do not yet know why your heart is racing, this section is not your next step.
Breathing slowly, for what we really know. A systematic review with meta-analysis that examined 223 studies showed that voluntary slow breathing increases the vagal component of heart variability: during the breathing exercise, immediately after, and also at a distance from a pathway of several sessions.
Said without exaggeration: we know that it shifts an index of parasympathetic tone, not that it cures tachycardia. It is however a zero-cost technique with very few expected side effects, and at the moment you feel the palpitations it gives you something to do instead of checking your pulse. What has been studied is the rhythm: slowing the breath, seated, for a few minutes.
Treating the neck because the neck is what hurts. For chronic non-specific neck pain there is moderate to strong evidence in favour of manual therapy on the cervical and thoracic spine combined with exercise, compared with exercise or manual therapy alone, on pain, function and satisfaction.
It is a good reason to take care of the neck, but the demonstrated benefit is on the neck, not on the heart.
Sleeping, moving, managing stress. Not because they free up a stiff neck, but because they act on the common root: sleep and regular physical activity affect anxiety and pain perception, and anxiety is the most solid candidate behind the combination of neck problems and tachycardia.
What a physiotherapist can do, and what they cannot
Let's put it in writing, because honesty on this point matters more than any technique: a physiotherapist cannot rule out a cardiac cause and does not treat tachycardia. That is the doctor's job, and there is no manipulation or exercise that replaces an electrocardiogram.
There is also a flip side to say clearly. If a professional, of any category, explains your palpitations with a cervical block and proposes a pathway instead of a medical visit, that is a reason to change professional.
What we can do is the rest, and it is not little: assess the neck and understand how much of your picture can really be traced back to it, teach you slow breathing and use it as a tool in moments of alert, build a progressive exercise programme for the neck, and help you read the diary to tell what moves together from what goes its own way.
If you have already had the electrocardiogram and the neck remains the problem, this is the moment when we can be useful: start with the questionnaire and have the first consultation by video call and we will assess together what is worth doing.
Telerehabilitation has a concrete advantage here: the physiotherapist sees you move at home, at the same workstation and in the same armchair in which the symptoms really appear.
In summary
That neck problems and tachycardia appear together is a common and real observation. That the first causes the second has not been demonstrated: when the cervical problem is surgically removed, dizziness and tinnitus improve, palpitations do not.
Barré-Liéou is a disproved historical label, irritation of the sympathetic was not seen when they measured it, and the best-documented reflex from the neck to the heart, that of the carotid sinus, leads to fainting and not to racing.
The explanations that hold up are others: pain that raises the rate, anxiety as a shared root, high breathing that loads the neck muscles, medications, and the attention that a sore body directs towards the heartbeat.
From here comes a simple sequence, and the order matters more than the individual steps. First, cardiac causes are ruled out with the doctor and an electrocardiogram, with no shortcuts. Then the neck is treated because the neck hurts, and you work on breathing, sleep and stress because they are the probable root.
Finally you observe: if the palpitations do not follow the neck, the answer was another one and must be looked for where it is.
And if at any moment chest pain, shortness of breath, cold sweats or the feeling that you are about to faint appear, the sequence is skipped and you call 112.
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Sources
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- Effect of Cervical Decompression on Atypical Symptoms Cervical Spondylosis: A Narrative Review and Meta-Analysis, World Neurosurgery, 2022
- Heart rate variability in adults with chronic musculoskeletal pain: A systematic review, Pain Practice, 2024
- Barré-Lieou syndrome and the problem of the obsolete eponym, The Journal of Laryngology and Otology, 2007
- Neck afferents and muscle sympathetic activity in humans: implications for the vestibulosympathetic reflex, Journal of Applied Physiology, 1998
- Carotid sinus syndrome, Cardiology in Review, 2015
- Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment, Journal of Clinical Medicine, 2022
- Heart rate variability and experimentally induced pain in healthy adults: a systematic review, European Journal of Pain, 2014
- Dysfunctional breathing: a review of the literature and proposal for classification, European Respiratory Review, 2016
- Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis, Chest, 2004
- Effects of Thyroid Dysfunction and the Thyroid-Stimulating Hormone Levels on the Risk of Atrial Fibrillation: A Systematic Review and Dose-Response Meta-Analysis, Endocrine Practice, 2022
- Effect of adrenergic agonist oral decongestants on blood pressure, Cochrane Database of Systematic Reviews, 2025
- Consumption of Caffeinated Products and Cardiac Ectopy, Journal of the American Heart Association, 2016
- Acute Effects of Coffee Consumption on Health among Ambulatory Adults, New England Journal of Medicine, 2023
- Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis, Neuroscience & Biobehavioral Reviews, 2022
- The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review, Journal of Back and Musculoskeletal Rehabilitation, 2017
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Last source check: August 2026.
