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A prospective, repeated measures cohort study with high school students was conducted in Montreal, Canada.To determine the incidence of neck and upper limb pain and associated risk factors in a cohort of adolescents.Neck and upper limb pain is frequent in adolescents and may be associated with repetitive motion from certain activities such as playing music, working, and engaging in sports activities.For this study, 502 students in the seventh to ninth grades in three schools were assessed. Data were collected at three times 6 months apart over a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and lifestyle factors and were measured for height and weight. Neck or upper limb pain occurring at least once a week in the preceding 6 months was defined as the outcome. Multivariate methods were used to model the repeated measures dichotomous outcome as a function of engaging in physical activity, working, or playing a musical instrument, adjusted for covariates.The cumulative annual incidence of neck and upper limb pain was 28.4%. The risk factors for neck and upper limb pain were working (adjusted odds ratio, 1.89; 95% confidence interval, 1.11–3.32) and lower mental health score (adjusted odds ratio, 1.68; 95% confidence interval, 1.19–2). Students involved in childcare were at a higher risk for the development of pain (adjusted odds ratio, 2.25; 95% confidence interval, 1.18–4.29).Neck and upper limb pain is common in teenagers. Sports involvement and music participation were not risk factors for the development of neck and upper limb pain. However, pain was more likely to develop in adolescents who worked than in students who had a lower mental health score.