If you’ve ever woken up with neck pain, you’ve probably wondered if your pillow is to blame. You try a new one — maybe firmer, maybe softer — and for a few nights, it seems better. Then the stiffness returns.
At Transform Chiropractic in Toronto, this is one of the most common questions we hear:
“What’s the best pillow for neck pain?”
The truth is, there’s no one-size-fits-all answer — but there are clear principles that make a pillow work with your neck, not against it.
Here’s how to choose a pillow that actually supports your spine, and helps you wake up more comfortable and rested.
Why Your Pillow Matters More Than You Think
During the day, your neck constantly supports the weight of your head — roughly 10 to 12 pounds. At night, the goal shifts. Your pillow’s job is to keep your head and neck in a neutral, balanced position so the joints, discs, and muscles can finally rest.
When your pillow is too high, too low, too soft, or too firm, the neck drifts out of alignment. The small stabilizing muscles at the base of your skull — especially the suboccipital muscles — tighten to protect the area. These muscles are packed with nerve endings and can easily irritate the greater occipital nerve, a common pattern behind morning stiffness or even headaches.
Over time, this irritation can contribute to:
Cervicogenic headaches (headaches originating from the neck)
Tension-type headaches from muscle fatigue
Postural strain from an unsupported cervical curve
Upper cervical dysfunction, especially around C1–C3
If you want a deeper explanation of how neck mechanics contribute to tension-type and cervicogenic headaches, visit our guide to headache treatment in Toronto.
Key Insight: The right pillow keeps your head, neck, and spine aligned in a straight, neutral line — reducing strain on joints, muscles, nerves, and the sensitive structures at the base of your skull.
Common Pillow Mistakes That Lead to Neck Pain
The most common pillow problems aren’t about brand or warranty — they’re about how the pillow holds your neck.
Pillow too high
When your pillow pushes your head forward, it flattens the natural cervical curve. This overstretches the joints in the back of your neck and forces the deep neck flexors to work all night. Many patients with forward head posture feel worse with thick pillows for this reason.
Pillow too flat
A pillow that’s too low lets your head fall backward, increasing tension in the front of the neck and compressing the joints at the base of the skull. This position often aggravates suboccipital trigger points and can mimic occipital neuralgia.
Too soft or collapsible
Down or low-density pillows often feel comfortable at first, but collapse under your head by the middle of the night. Without consistent support, the neck shifts into subtle side-bending or rotation, leading to morning stiffness.
Stacking multiple pillows
Two or three pillows force your neck into awkward angles, creating asymmetry in the joints and overstretching one side of the spine.
Using the same pillow for every sleep position
Side sleepers, back sleepers, and stomach sleepers all need different support heights. What works for one position rarely works for all.
If your pillow isn’t keeping your neck roughly aligned with your spine, it’s not doing its job.
The Best Pillow by Sleeping Position
If You Sleep on Your Back
Back sleepers do best with a pillow that supports the natural cervical curve while allowing the head to rest comfortably without excessive elevation.
Look for:
A medium-firm pillow that gently cradles the neck
A slight contour that supports the curve rather than just the back of the head
A small dip or cradle for the back of the skull, which helps prevent rolling into extension
Avoid thick or overfilled pillows — they push the head forward and strain the deep stabilizers.
Avoid pillows with extreme curves built in, particularly very firm pillows. While the theory that they support the natural neck curve is true, they are often too extreme, and will cause more neck pain, especially initially.
For some people looking for a type of curve to support the natural alignment of the neck, a small towel rolled up and placed under the neck can be a good first step, or a small soft “roll” type pillow.
This can be a good first step to see if this type of pillow may be comfortable for you longterm, and may save you spending a lot of money on a specialized pillow if you don’t find this first step comfortable.
Because forward head posture is one of the most common contributors to upper cervical stress, you may also find our full guide on posture correction helpful for understanding how daily alignment influences headaches.
If You Sleep on Your Side
Side sleeping can be excellent for neck comfort, but only if the pillow fills the space between the ear and the shoulder.
Look for:
A higher-loft pillow that keeps your head level and neutral with your spine
Medium to firm density, so your head doesn’t sink unevenly
Consistent width from front to back, preventing side-bending
If your pillow is too soft or collapses while you sleep, your neck will tilt downward, straining the joints on one side.
A pillow with a built in curve isn’t necessary for a side sleeper, since the pillows main job is to keep your head in alignment (in the same plane) with your neck and midback.
If You Sleep on Your Stomach
Stomach sleeping is the hardest on your neck because it forces the spine into rotation for long periods. If you must sleep this way:
Use a very thin pillow, or no pillow at all under your head
Place a small pillow under your chest to reduce neck rotation
Try transitioning gradually toward your side or back using body pillows
Even subtle improvements in positioning may make a difference in reducing morning neck irritation.
What About Orthopedic and Memory Foam Pillows?
Specialty pillows can help — but only if they match your body type and sleep position.
Memory foam
Memory foam contours well and maintains support throughout the night, which many patients appreciate. However, some versions are overly firm or retain heat, which can reduce comfort and increase muscle tension.
Water or adjustable-fill pillows
These offer customizable height and firmness. They’re excellent for dialing in neck support, though heavier and sometimes harder to fine-tune.
Down or feather pillows
Soft and breathable, but they compress easily, leading to poor alignment after a few hours.
The ideal pillow is less about the material and more about how well it supports your neck’s structure and maintains alignment throughout the night.
The reality is, your pillow has to interact with your daytime posture more than most people realize.
If forward head posture or upper-back rounding has already shifted the way your neck sits, even a well-designed pillow may struggle to keep your cervical spine neutral.
In these cases, the pillow isn’t the entire problem — it’s compensating for deeper mechanical changes.
That’s why many people feel temporary improvement after switching pillows but still wake up stiff: the underlying alignment issue is still present.
The Chiropractic Perspective: Why Your Pillow Can Only Do So Much
A great pillow can support healthy posture at night — but it can’t correct structural changes that have developed over months or years.
If you’ve lost the normal cervical curve, or if your upper cervical joints are restricted, even the best pillow won’t fix the underlying issue. Many patients tell us they’ve “tried every pillow imaginable,” but still wake up sore. This is usually a sign that the mechanics of the neck need attention first.
At Transform Chiropractic, we start by assessing:
Your posture and spinal alignment
Cervical joint mobility
Muscular imbalances
Thoracic spine stiffness
Digital X-rays (if needed) to evaluate underlying structure
Once the neck begins moving and functioning properly again, your pillow can finally support those improvements — instead of compensating for deeper issues.
You can learn more about why morning stiffness often has deeper mechanical roots — not just the pillow itself — in our guide on why your neck pain isn’t just from sleeping wrong.
A Quick Pillow Fit Test (30 Seconds)
You can check your pillow simply by lying down:
On your back: Your nose should point straight up. If your chin tilts toward your chest or rises upward, your pillow height is off.
On your side: Your nose should align with the center of your chest. If it angles up or down, adjust your pillow height.
Neck muscles: You should feel supported enough that your neck muscles relax, not strain to hold you up.
A good pillow makes your neck feel weightless, not braced.
Simple Ways to Support Better Sleep and Neck Health
Stay on your back or side when possible
These positions reduce rotation and keep your spine more neutral.
Use a pillow that supports your natural curve
Look for something that fills the space beneath your neck, not just behind your head. This is a key to sleep comfort.
Replace pillows regularly
Most pillows break down within 12–18 months, even if they look fine on the surface.
Do a gentle chin tuck exercise before bed
The Neck Retraction / Chin Tuck Exercise helps reduce suboccipital tension and prepares your neck for better sleep.
Create consistent sleep routines
Going to bed and waking at similar times helps the nervous system down-regulate and recover.
Small details add up — especially when you spend about a third of your life sleeping.
If morning neck stiffness persists, explore our guide to neck pain treatment in Toronto for a deeper look at joint motion, posture, and the underlying mechanics that may be contributing.
Frequently Asked Questions
How do I know if my pillow is causing my neck pain?
If your neck feels stiff or sore upon waking, but eases after moving around, your pillow likely isn’t supporting your proper neck alignment.
Are cervical pillows really better?
They can be — as long as the contour matches your body size and sleep position. A contour that’s too high or too firm can actually worsen symptoms in some cases.
What pillow do chiropractors recommend?
One that keeps your head in line with your spine. For most people, that means a medium-firm pillow with a gentle neck contour.
Can a pillow fix chronic neck pain?
Pillows help reduce strain, but long-term improvement usually requires restoring proper movement and alignment through chiropractic care and postural correction.
Sleep Should Help You Heal — Not Hurt
The right pillow can make a noticeable difference in how your neck feels each morning, but it’s only one piece of the picture. If you’ve tried multiple pillows and still wake up stiff or uncomfortable, it may be time to take a deeper look.
At Transform Chiropractic in Toronto, we help you identify — and correct — the underlying structural issues that keep your neck from relaxing at night, so your pillow can finally do its job.
Book a neck and posture assessment and start waking up feeling rested, not tight.
Written by Dr. Byron Mackay, Chiropractor — Transform Chiropractic, Toronto
Updated December 2025
