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Headshaking

By: Dr.Philip Johnson

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Diagnosis

The headshaking syndrome is largely diagnosed based on observation of the abnormal behavior and reviewing the horse's medical background. Other possible causes must be considered and ruled out using appropriate diagnostic tests. However, the headshaking syndrome, an irritation of the trigeminal nerve branches, appears to be the most common cause of headshaking in horses in North America and Western Europe.

Treatment

Unfortunately, many affected horses fail to respond to any and all of the available treatments and there is not a single treatment option that is universally effective.

  • Medication. Some drugs that may reduce the effects of trigeminal neuralgia, such as cyproheptadine and carbamazepine, have been used to good effect in some horses affected with headshaking.

  • Eye shading. Specially developed tinted contact lenses and eye shades (sun glasses) have been useful in some of those horses in which bright light appears to aggravate the headshaking behavior.

  • Scarring of the trigeminal nerve. If anesthesia of a part of the trigeminal nerve is shown to ameliorate headshaking behavior, some veterinarians have elected to either cut or permanently scar (injection if a chemical sclerosing agent) those parts of the trigeminal nerve, although these procedures have not been universally successful. Scarring of the deeper portions of the trigeminal nerve must be performed under general anesthesia.

    Surgical cutting of the trigeminal nerve should not be undertaken lightly; a common complication (apart from the possibility that the procedure may fail to stop the headshaking problem) is development of a new abnormal nerve sensation (neuroma) at the site of the surgery. Trigeminal neuroma formation may, in some cases, lead to abnormal facial sensation and pain when the horse's head is handled. The last thing you want is a horse that is worse, and possibly disfigured.

  • Facial mask. Being fitted with a special mask (nasal mask) that either reduces the intake of dust or attenuates the airflow through the nasal passages helps some affected horses. You can even try something as simple as a nylon stocking at first as a test, although this obviously does not block the wind completely.

  • Tracheostomy. A treatment of relatively last resort is the permanent tracheostomy; many severely affected horses can be managed by providing the alternative airway and abrogating the triggering effect of airflow in the nasal passages.

  • Acupuncture. There are many claims that acupuncture reduces the signs of headshaking but there have been no controlled studies in horses or humans with the similar disease to date.

  • Euthanasia. Euthanasia is elected for some of the severely affected horses for which attempted treatment options have failed. As a testament to the mental anguish with which horses affected with the headshaking problem are subjected, a common consequence of trigeminal neuralgia in human patients is suicide.

    Other Consequences

    In many cases, the affected horses are sold during the early stages of the disease while the headshaking behavior is episodic and the horse might be seen to be unaffected. In some cases, insurance companies are asked to pay for the cost of "loss of use" (depending on the insurance policy.) A number of horses affected with severe signs of headshaking are euthanatized.

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