This chapter describes approach to the patient with neck pain. Neck pain is common in the adult population with a reported prevalence of 26–71% resulting in significant disability and economic costs. Initial evaluation of the patient with neck pain is focused upon identifying acute or concerning pathology that include fracture or instability due to trauma, neurologic deficits from nerve injury or compression, oncologic etiologies, systemic illness, and infection. Neck pain without concerning presentation should initially be treated with conservative measures such as anti-inflammatory medications, over-the-counter analgesic medications, activity modification, and physical therapy as the majority of episodes will improve with these modalities without the increased risk associated with procedural interventions or more potent prescription medications. Imaging of the neck and spine in patients without concerning presentation is not indicated unless pain remains refractory to conservative measures (3 months for plain radiographs or 6 months for MRI) or during consideration of interventional or surgical treatments.