BACKGROUND: Neck pain is a common presentation in general practice, with muscle strain or osteoarthritis the most common diagnoses. A systematic approach for identifying red flags for alternative causes is required to appropriately investigate or refer for specialist opinion. OBJECTIVE: The aim of this article is to highlight features of neurological and other causes of neck pain in adults that may present in general practice, and to outline a quick and practical diagnostic approach. DISCUSSION: Neck pain in adults may result from musculoskeletal or neurological disease, or as a component of a wide variety of metabolic, infective or malignant disorders. Focused attention to those components of history and examination that suggest alternative conditions can assist the diagnostic process.