Pillow for Headaches: What a Pillow Can and Cannot Do

A pillow can contribute to headaches when its height leaves your neck bent for hours, but it is rarely the only cause, and no pillow treats headaches. If your head and neck sit in a neutral position all night, you remove one possible source of neck strain. A fitted pillow is an adjunct to care, not a treatment.

Key takeaways

• Some headaches, especially those that start in the neck or show up in the morning, can be linked to neck position and muscle tension. A pillow that is too high or too low can add to that strain.
• Migraine, cluster headaches and headaches from other medical causes are not fixed by a pillow. Sudden, severe or unusual headaches need medical evaluation first.
• A Pillowise pillow is chosen from 7 sizes using three body measurements, your sleeping position and your mattress firmness. A provider near you takes the measurements for free.

Can the wrong pillow cause headaches?

It can play a part for some people. Headaches are not one condition. Tension-type headaches, headaches that originate in the neck (often called cervicogenic headaches) and migraines have different causes and need different care.

The pillow matters mainly for the first two groups. When your pillow does not fill the space between your head and the mattress, the neck tilts for hours. The muscles at the base of the skull and along the neck work overtime, and some people wake up with a tight neck and a headache that starts at the back of the head.

We want to be clear about the limits. We do not have a study to cite showing that changing a pillow prevents or cures headaches. What we can say is that pillow height is one factor you control at home, and that a poor fit is a reasonable thing to rule out. If you wake up stiff as well, our post on strategies for improving morning stiffness covers what providers look at.

Which headaches are unlikely to improve with a pillow?

A pillow is not the answer to every headache. These are the situations where it probably will not help:

• Migraine. Migraine is a neurological condition with its own triggers. A better pillow does not address them.
• Headaches that begin after a head injury. These need an evaluation.
• Headaches with other symptoms. Fever, a stiff neck, vision changes, confusion, weakness or numbness need urgent medical care, not a new pillow.
• A new, sudden or "worst ever" headache. Seek care right away.

If your headaches are frequent, getting worse or changing in pattern, see your own physician or provider before you shop for anything.

How does pillow height affect the neck?

The right height depends on how far your head sits from the mattress in your sleeping position. Three things set that distance: your body, your position and your mattress.

• Side sleepers have the largest gap, because the shoulder is the widest point between the head and the mattress. A pillow that is too low lets the head drop toward the mattress. One that is too high pushes it away.
• Back sleepers need less height. A pillow that is too high pushes the chin toward the chest.
• Stomach sleepers turn the head to one side for hours, which is hard on the neck whatever the pillow. A lower pillow is usually easier on the neck in this position, and a fitting can help you choose.
• Mattress firmness changes the gap. On a soft mattress, including many memory foam and hybrid models, your shoulder sinks in and you need a lower pillow than on a firm mattress.

This is why a single stock height, whether standard, queen or king, cannot suit everyone. Pillow size names describe the dimensions of the pillow, not whether it fits your body. Our post on how to tell if your pillow is the wrong height lists the signs to look for, and why a fitted pillow explains the reasoning behind choosing a pillow like a shoe size.

How does Pillowise choose a pillow?

A Pillowise pillow comes in one of 7 sizes. The Pillowise algorithm picks the size by combining five factors:

1. Shoulder width. This sets the gap a side sleeper has to fill.
2. Neck circumference. Measured at C4/C5, below the Adam's apple for men.
3. Neck height. Measured from the mastoid process diagonally to the outer edge of the acromion.
4. Sleeping position. This is the position in which you fall asleep: side, back or stomach. If you are unsure, choose side.
5. Mattress firmness. Soft, medium or firm. If you do not know, choose medium.

The system indicates the right size for about 95% of people. Weight is not part of the calculation. A heavier person sinks deeper into the mattress and may need a lower pillow, so a provider checks your position on the pillow and adjusts if needed, for example during pregnancy. You can see what the visit looks like in what happens in a pillow fitting.

The standard Pillowise pillow measures 22 x 14 inches. The core is 100% premium Dutch memory foam, non-toxic and latex-free. The cover has a Tencel top layer on polyester, removable and machine washable at 104°F.

What if the pillow does not feel right at first?

Give any new pillow 7 to 10 days to adjust. If it still does not suit you, Pillowise has a 30-day comfort guarantee: you can exchange it for another size or return it for a refund within 30 days of purchase. Return shipping is paid by the customer, and shipping charges are not refunded.

If you track your headaches, note the days and the time of day they start for a few weeks before and after the change. That gives you and your provider something concrete to look at, rather than a guess.

Find a provider near you

Pillowise is sold only through licensed healthcare providers in the US: chiropractors, physical therapists and licensed massage therapists. There is no retail store and no direct webshop. The measurement is free at every provider. Use the Find a Reseller page to book one.

If you want a rough idea of your size first, the pillow height calculator walks you through the manual measurement. Ideally a second person takes the measurements. Questions about the process are answered in the FAQ. If you want to use an FSA or HSA, ask your plan administrator whether a pillow is eligible.

Scope of this guide

This guide is general information, not medical advice. A fitted pillow does not diagnose or treat headaches. Treat it as one part of a sleep setup, alongside the care plan you agree with your own provider.

For providers

If you treat patients with neck-related headaches, sleep position is the part of the picture they bring home every night. See Pillowise for chiropractors, PTs and LMTs to register as a reseller.

Find a Pillowise provider near you for a free measurement.

Thijs van der Hilst, physiotherapist
Co-founder of Pillowise