A new study presented at the 2017 International Stroke Conference (ISC) suggests it does not matter whether a patient’s head is elevated or lies flat following an acute stroke. Researchers of the international study said they found no major benefit to either sitting up or lying flat patients who have had an acute ischemic stroke or intracerebral hemorrhage, which results from bleeding in the brain.

“The important message is that head position doesn’t seem to matter,” said lead researcher Craig. S. Anderson, M.D., Ph.D., professor of stroke medicine and clinical neuroscience medicine at the George Institute for Global Health in Sydney, Australia. “It has no effect on recovery, the patient’s sense of well-being or mortality.” The study is the largest randomized nursing care trial ever, with more than 11,000 patients from 114 hospitals participating worldwide.

Patients in the study either laid their head flat or had their head positioned at least 30 degrees for the first 24 hours of a hospital admission for a stroke.  The researchers followed up with the patients and found that ninety days later there was no difference in prognosis for the stroke victim based on whether their head was up or down following a stroke.  The study also accounted for the age of the patient, type and region of the stroke or time from when symptoms began.

The researchers noted that patients who had their head lay flat were uncomfortable and showed no better outcomes than those whose heads were up during the first 24 hours after a stroke. There was no serious side effects or varying rates of pneumonia, which “should be reassuring” to developing countries, where patients usually lie flat in nonmechanical beds said Dr. Anderson.

Smaller studies conducted have indicated that lying flat may improve survival rates and recovery from an acute stroke by increasing the blood flow and oxygen to the brain. Others have argued that this may increase the risk of pneumonia, and that sitting up may reduce pressure to the brain.


Strokes are the second leading cause of death worldwide, and result in 795,000 deaths each year in the United States.  87 percent of strokes are caused by a blocked blood vessel, or blood clot in the arteries that surround the brain, and are called an ischemic stroke.

Source: American Heart Association News, “Head position after stroke: Up or Down? (http://news.heart.org)