Head Position for Concussion Patients
For patients with concussion (mild traumatic brain injury), elevate the head of the bed to 30 degrees with the head maintained in a midline position to optimize venous drainage while minimizing aspiration risk. 1
Primary Positioning Recommendation
Elevate the head to 30 degrees as the standard position for most concussion patients, which provides the optimal balance between reducing intracranial pressure and maintaining adequate cerebral perfusion. 1
Keep the head in a midline position (straight alignment) to ensure unobstructed jugular venous outflow and prevent increases in intracranial pressure from head rotation. 1
When to Modify the Standard 30-Degree Position
Consider Flat (0-Degree) Positioning If:
The patient has no risk of aspiration (intact swallowing, normal consciousness level) and no signs of increased intracranial pressure, as the supine position maximizes cerebral blood flow. 1, 2
The patient is hypovolemic or hypotensive, since head elevation can reduce cerebral perfusion pressure in these circumstances. 1
This flat positioning is particularly relevant in the first 6-12 hours when maximizing cerebral perfusion may be prioritized. 2
Increase to 30-45 Degrees If:
The patient has confirmed dysphagia or aspiration risk, as elevating the bed to at least 30 degrees significantly reduces aspiration complications. 1
There is decreased level of consciousness that increases aspiration risk. 1, 2
Signs of increased intracranial pressure develop (headache worsening with position changes, vomiting, altered mental status). 1
Critical Monitoring Parameters
Assess neurological status every 4 hours at minimum, including level of consciousness, pupillary response, and focal neurological deficits. 1
Monitor for worsening symptoms when changing head position, including increased headache, nausea, dizziness, or confusion. 1
Ensure airway patency is maintained regardless of position, avoiding slumped sitting that can compromise oxygenation. 1
Check blood pressure when elevating the head, as some patients may experience orthostatic hypotension that reduces cerebral perfusion. 1
Common Pitfalls to Avoid
Do not keep patients immobilized in one position for extended periods; regular position changes prevent complications while maintaining head elevation principles. 1
Avoid head rotation to either side as this impedes jugular venous drainage and can increase intracranial pressure. 1
Do not elevate the head if the patient is hypovolemic without first addressing fluid status, as this can critically reduce cerebral perfusion pressure. 1
Never assume one position fits all patients; while 30 degrees is the standard starting point, individual monitoring of cerebral perfusion pressure and intracranial pressure at 0°, 15°, and 30° may be warranted in patients with more severe symptoms. 1
Practical Implementation
Start with 30-degree elevation as the default position for all concussion patients upon initial assessment. 1
Perform bedside swallowing assessment before allowing oral intake; if swallowing is impaired, maintain at least 30-degree elevation and keep patient NPO. 1
Position on the affected (paretic) side if significant hemiparesis is present, as this facilitates communication and reduces aspiration risk. 1, 2
Adjust transducer position when measuring blood pressure to ensure accurate cerebral perfusion pressure calculations at different head elevations. 1