The main aim of this study was to explore the occurrence and changes of neck pain in pain-free preadolescents. The evaluation was performed at 1- and 4-year follow-ups. Of the pain-free preadolescents, 366 (71.9%) completed structured pain questionnaires at 1 and 4 years. The occurrence of neck pain at least once a month was 21.3 and 43.4% and at least once a week was 6.3 and 19.4%. Sex difference was found only at the 4-year follow-up, when subjects were 13-16-year-old. Neck pain was then more common among girls than boys (P < 0.001). The intensity of pain increased with the frequency of pain (P < 0.001). Of those with neck pain, 28% had used painkillers. The proportion increased with the frequency of neck pain (P = 0.054). Neck pain occurred more often with some other musculoskeletal pain than as a single pain. The frequency of neck pain correlated with the frequency of headache (r = 0.39 [95% confidence interval (CI), 0.30-0.47]) and with the disability (r = 0.26 [95% CI, 0.16-0.35]). This study strengthens the results of the previous cross-sectional studies that occurrence of neck pain increases with age, and that neck pain becomes more common among girls than boys in adolescence. Among preadolescents who were originally pain-free, there was only a small proportion who reported frequent neck pain at both 1 and 4 years. It also showed that the frequency of neck pain reflects the intensity of pain fairly well.