Orthopedic pillows can significantly help certain types of neck pain by keeping the cervical spine closer to neutral overnight and reducing protective muscle guarding. Benefits are often clearer when morning pain is driven by an incorrect pillow height. However, the pillow is not always the root cause. Disc-related pain, facet joint issues, myofascial trigger points, and postural problems may require exercise therapy and clinical evaluation; in these cases the pillow is supportive. A short adaptation phase is normal, but worsening pain suggests the height or firmness is not a good match and should be reassessed.