The Takamakura (or neck rest) was often used with a Sobakawa (or neck cushion). The cushion would be tied down with a string and attached to the neck rest through a small hole. You would then put a small cloth over the cushion to protect it from grease and sweat.
This particular piece was owned by Mary Cordelia Scott (1895-1972) who was a nurse and missionary living in Japan for 31 years. She returned to her family in Pakenham with many items from her travels, including this neck pillow.