Head position in acute stroke: an editorial on the HeadPoST trial

According to the World Health Organization in the Global Status Report on Noncommunicable Disease in 2014, stroke is one of the leading causes of death worldwide (1). They reported that in 2012 there were 17.5 million deaths, and 6.7 million among them were due to strokes. In the United States about 800,000 strokes occur each year, and 87 % of all cases are ischemic stroke (2). While patients do show recovery over time, many still demonstrate significant impairment, being a leading cause of disability. The potential benefit of lying flat after stroke comes from the idea that it can increase blood flow in major arteries of the brain. However, providers are concerned about increasing the risk of aspiration pneumonia, cardiac respiratory impairment, and prolonging immobilization. On the other hand, sitting-up positioning may reduce intracranial pressure and cerebral edema. The role of head positioning in prior studies have indicated that this potential modification in acute stroke management could improve outcomes and enhance recovery (3,4). Nevertheless, large scale randomized clinical trial have not been undertaken to show that head positioning affects outcomes after acute ischemic stroke or intracerebral hemorrhage.