Although neck pain is a common source of disability, little is known about its incidence and course. We conducted a population-based cohort study of 1100 randomly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course. Subjects were initially surveyed by mail in September 1995 and followed-up 6 and 12 months later. The age and gender standardized annual incidence of neck pain is 14.6% (95% confidence interval: 11.3, 17.9). Each year, 0.6% (95% confidence interval: 0.0-1.1) of the population develops disabling neck pain. The annual rate of resolution of neck pain is 36.6% (95% confidence interval: 32.7, 40.5) and another 32.7% (95% confidence interval: 25.5, 39.9) report improvement. Among subjects with prevalent neck pain at baseline, 37.3% (95% confidence interval: 33.4, 41.2) report persistent problems and 9.9% (95% confidence interval: 7.4, 12.5) experience an aggravation during follow-up. Finally, 22.8% (95% confidence interval: 16.4, 29.3) of those with prevalent neck pain at baseline report a recurrent episode. Women are more likely than men to develop neck pain (incidence rate ratio=1.67, 95% confidence interval 1.08-2.60); more likely to suffer from persistent neck problems (incidence rate ratio=1.19, 95% confidence interval 1.03-1.38) and less likely to experience resolution (incidence rate ratio=0.75, 95% confidence interval 0.63-0.88). Neck pain is a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability.