One of the most important signs of meningitis is called neck stiffness. It is a contracture of the muscles in the neck area along with muscular pain and often accompanied with headaches. Neck stiffness counts as another meningeal symptom, and it is also known as nuchal rigidity. Even though this symptom is very common, not every patient needs to have neck stiffness to consider meningitis as a possible diagnosis.
For example, neck stiffness is not as common in children as it is in adults, and it is less frequent in meningitis associated with Lyme disease. It is often absent in younger children, even if they have seizures, fever, and other severe symptoms of the disease. In most adults, neck stiffness marks the start of the meningeal symptoms and it is often preceded by 2 days of mild fever as the prodromal state of the disease.