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Choosing the Perfect Pillow

With neck pain a common symptom of migraine and disturbed sleep a common migraine trigger, it isn’t surprising that most migraineurs appear to be on a never-ending search for the perfect pillow. Though I cannot recommend the perfect pillow to solve everyone’s woes, here’s what I’ve learned over the years from doctors, chiropractors, massage therapists and physical therapists.

Basically, you want to have the same good posture when you’re sleeping as when you’re standing up. Which means that the first and most important consideration when choosing a pillow is the primary position in which you sleep.

If you sleep on your back, your neck should be supported and your head shouldn’t be raised too high. A soft or thin pillow works well for back sleepers. One that has support for your neck, like a molded memory foam pillow achieves this goal. A cervical pillow, which is a round tube of a pillow that only goes under your neck works well, too. You can test out neck support by rolling up a towel and sleeping on that to see how it feels. This isn’t the ideal solution as it flattens out throughout the night, but is a good way to try it before spending money on yet another pillow.

Side sleepers need a pillow that will fill the space from their shoulder to their head, keeping the neck at the proper alignment. The filling needs to be of medium to firm density to hold up your head all night. If you’re at a store that doesn’t have a place to test pillows lying down, you can stand against the wall and tuck the pillow between your head and the wall. Just remember that your shoulder compresses some when you lie on it. It is helpful to bring someone shopping with you to tell you if your neck looks like it is aligned properly.

As far as I can tell, stomach sleepers are out of luck. Unless you sleep with your face in the cradle of a massage table, there’s no way to sleep on your stomach without wrenching your neck.

Once you’ve decided on density, pillow material is an individual choice. There’s no one best material — what matters is find one that’s comfortable for you. If you are sensitive to odors, be sure to smell pillows, especially those made of synthetic material, before buying one. Many stores do not accept returns on pillows for hygienic reasons.

I know many a migraineur with a pillow graveyard in their guest rooms. I’m one of them: water-filled, down, synthetic down, buckwheat, latex, wool, memory foam, fiberfill, microbeads…. I’ve spent a small fortune trying them all. I continually return to lumpy synthetic fiberfill for side sleeping and use a cervical roll when sleeping on my back. It is not ideal, butis the best I’ve come up with.

Have you found a wonderful pillow that allows you to sleep well and wake up without neck pain? Please share!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Teresa
    4 years ago

    I have this problem as well. I am a side sleeper, but I have to have a pillow to “hug” with arms and legs. I found a perfect pillow for me called the ComfortU pillow. It was made by someone who suffers from fibromialgia. It is a large pillow that is shaped like a U, but would be about 6′ if straightened. It is perfect because, since it is a U shape, if you turn over during the night, you still have your “hugging” pillow on the other side. It worked great at first, but like all pillows, the head area got too flat after a while. Since this is all one piece, I could not just replace the part under my head, and the pillow costs about $100 on Amazon, so I was not just going to buy another one. I ended up turning the pillow upside down where the head is actually at my feet, and just buying a new pillow for my head so I still have my body hugging pillow. Unfortunately, I am back to square one trying to find the right pillow to support my head and neck properly. Be advised though, if you think about buying the ComfortU pillow, it takes up a lot of room in the bed. Your significant other might get pushed out, lol.

  • tucker
    6 years ago

    Wow, I’ve not only done the pillow thing $10-$100 pillows – but the mattress thing too. I sleep with this little “surround” of pillows – one under my head (currently a water pillow that I’ve used for a while, left and come back to (and yes it weighs a ton and goes with me when I travel) + an old lumpy travel pillow to support my head if I sleep on my back so my head can stay straight, a pillow beside me in the middle of the bed (poor hubby gets shunned but it does keep him from flopping that big heavy leg across me) and a pillow under my legs.

    I sleep on my back and both sides so I definitely need the pillow under my legs or between my knees to help my low back. But if I spend too much time on either side my shoulders will hurt so much in the morning I can barely move. My PCP says I am “too thin”. Whatever. That’s where my mattress confusion comes in.

    We bought a pretty expensive mattress several years ago that seemed to be a compromise for hubby and myself. He spends most of the night on the couch – just falls asleep watching tv then comes to bed. Actually, the couch is pretty comfy since you have the support of the back of the couch. You just have to swap ends. I’ve added more cushioning as mattress toppers, taken them off, put them back on – all trying to decide what helps my back and shoulders and body and neck feel best.

    The best nights sleep I got was during a sleep study last summer on the sleep number mattress. I’m a 60. Forever ingrained in my head since it took 2 tries. Too bad they don’t make a adjustable pillow so we can adjust it’s firmness, temperature, shape, etc for what we need at the moment. Heat for neck pain, cold for a migraine, cool for summer, warm for winter, soft for back, firm for side, squishy in middle with firm side to support our heads on our back – ahhhhh…

  • Holly
    7 years ago

    I have a round tube pillow I must always sleep with. Before I had it I use to sleep with my arm under my neck. Never put it together with my migraines. When I have a severe one that has been a few days I find sleeping @ a 45 degree angle helps me fall asleep easier and not wake up with it being so svere. However once I am up and moving around it worsens all over. So” at best” it is a temporary fix.

  • alig0118
    7 years ago

    I’ve tried so many pillows that I’ve lost count. Recently, my chiropractor recommended a pillow to me about a month ago. It was more expensive then most of the shoes I buy and I was very reluctant to buy it. Holy heck, I didn’t know how much neck pain I was living with until I bought this pillow and used it! I wake up without neck and shoulder pain. The pillow by Therapeutica, called The Ultimate Sleeping Pillow. It is for back and side sleepers, has a crazy shape, and is made from a specially-developed foam (not memory foam). It comes in five sizes and have the ‘average’ size. I don’t usually talk up a product, but this pillow is amazing.

  • Julie
    7 years ago

    I too have a pillow graveyard in a spare bedroom. I’ve yet to find the perfect pillow. It’s frustrating. i’ve tried several memory foam, water filled, cervical neck rolls. I sleep on my LH side only and I start out the night w/1 pillow and it ends up on the floor w/a reserve pillow in the center of the bed ready to take it’s place and it soon joins the one on the floor and my 3rd in line is next. Soon it joins the pile on the floor. I will get up and start again w/pillow #1. My husband jokingly said 1 time that he’s going to duct tape 1 pillow to my head so that I stop tossing them on the floor. Well then next I’ll have a heavy duty pair of scissors on my nightstand for just such an event.

  • Cindi
    7 years ago

    Where was this article 5 years ago when I was doing my own pillow search? HA! Great article and important, because our quality of sleep means alot.

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