What should you know about painful lump in the back of my neck?

The back of the neck contains muscles, skin, hair follicles, and lymph nodes that drain areas of the scalp and upper neck. A tender lump may follow a scalp irritation, skin infection, insect bite, or a recent cold. A cyst or tight muscle can also feel like a distinct bump, especially when touched or when the neck moves.

[Head and Neck Cancer](/conditions/head-and-neck-cancer/) and [Lymphoma](/conditions/lymphoma/) can present with a neck mass, but a painful lump does not establish either diagnosis. [Cancer of Unknown Primary](/conditions/cancer-of-unknown-primary/) is considered only in a specific clinical situation when cancer is confirmed and its starting site is not found.

Look for scalp sores, redness, warmth, drainage, recent injury, or a new hair or skin product. Do not squeeze or puncture the lump. Gentle neck movement may be reasonable if comfortable, but stop if it increases pain. Arrange a clinical visit if the lump lasts, enlarges, becomes firm or fixed, or cannot be linked to a short-lived irritation.

The clinician may inspect the scalp and skin, examine the neck and lymph-node chains, and decide whether observation, treatment for infection, imaging, or sampling is appropriate.

Seek urgent help for rapidly increasing swelling, severe headache with fever, confusion, neck stiffness, breathing or swallowing difficulty, or spreading redness. Seek prompt assessment for night sweats, unexplained weight loss, persistent hoarseness, arm weakness, or a lump that continues to grow.

Ask: Could this arise from my scalp or skin? Does it feel like a lymph node, cyst, or muscle? How long should I monitor it? Would imaging or a biopsy be useful? What symptoms mean I should return sooner? If testing points to the thyroid, would [Thyroid Removal Surgery](/treatments/surgical-oncology/thyroidectomy/) be discussed?