Chances are your veterinarian does not have all the answers, nor do we. 
Your veterinarian can be a valuable partner to help you navigate through the condition and the information available so that you can choose the best course of action for your horse.  

The First Step

Once your horse has been diagnosed with headshaking, you and your veterinarian should work together to decide the path that best fits you, your horse, and your wallet.  

There are basically two ways to proceed, both of which can be tailored to fit your budget and needs; neither path is right or wrong, they are simply different.

Path one: Perform diagnostics to rule out any medical causes of the behavior.

Path two: Try physical, dietary, drug, or combination therapy and see which methods, and to what extent, they modify your horse's behavior.

Path One

Do you want to pursue diagnostics to rule out other causes?  There may be other reasons for your horse to shake its head.  As we said before, some headshaking symptoms appear as exaggerated "normal" behaviors. 
There have been cases where other causes were identified for the behavior.  In the horses that we have seen, these causes included:

  • A foxtail in the false nostril - one case
  • Large corpora nigra cysts in the eye - one case
  • Tooth abscessation (infection in a tooth) - two cases
  • Sinusitis (infection in the sinus) - several cases, all had nasal discharge

They may also include:

  • Occasionally a horse living on a property where a respiratory outbreak has occurred may exhibit transient (temporary) headshaking for several months presumably due to irritation of the trigeminal nerve caused by inflammation secondary to (caused by) a viral infection.

Remember; your veterinarian can perform a slew of diagnostic tests.   These tests are not performed to diagnose headshaking: they are performed to rule out other possible medical causes of the behaviors your horse is exhibiting.  If a medical problem is the cause of your horse's behavior, it won't get better until it is diagnosed and treated.

What this means is that all of these diagnostic tests can and usually are "normal", but your horse can still have headshaking syndrome.   

Diagnostics commonly performed for headshakers;

Radiographs:

Radiographs can be performed to rule out abnormalities of the tooth roots and sinuses or middle ear disorder that might indicate an infection or tumor.

Endoscopy:

Endoscopy involves putting a small flexible video camera into the nasal passages and guttural pouches via the nostril.  This diagnostic test might be performed to rule out abnormalities of the sinuses, guttural pouches, and ethmoid turbinates.  These could include ethmoid hematomas, abscesses, etc...

Dental examination:

Dental examination using a full mouth speculum can be performed to evaluate the oral cavity and check for dental disease such as teeth fractures, diastema etc.

Ear Examination:

Due to its narrow and deep anatomical design, it is very difficult to perform a full examination of the horse’s ear canal without deep sedation and a small endoscope.  However, an ear exam can show evidence of significant infection, ear mites, ticks, foreign bodies, tumors, masses, etc.

Path Two

Keeping in mind that all of the diagnostics listed above have a cost, and varying levels of invasiveness, and that none of them may diagnose a medical cause for headshaking syndrome in your horse, some owners choose to evaluate response to treatments rather than pursuing extensive diagnostics tests once your veterinarian has diagnosed headshaking syndrome in your horse.  A physical exam and behavioral observations are essential.  This would include video of the horse demonstrating the behavior. Again, this is a decision that you should make with your veterinarian considering your needs, the needs of your horse, the limitations of your budget, your horse's specific clinical signs, and the degree to which your horse's specific clinical signs are exhibited.  As we said before, if a medical problem is the cause of your horse's behavior, it will not improve until this is addressed.

If you choose this path, you might consider following these steps.  Refer to the treatment options page and remember to monitor your horse for signs of adverse reactions or overdose when using supplements or drug therapies.  Always keep your veterinarian informed of supplements and treatments you are using as they may interact with other drugs or treatments. 

We strongly recommend trying treatments individually to determine if your horse responds to each treatment.  If you start with combination therapy, you won't know if your horse is responding to one or both of the treatments.  Once you have identified the treatments that help your horse, you and your veterinarian can decide what combination of treatments is appropriate. Start with simple physical treatments (masks etc.).

A word of caution; headshaking comes and goes sometimes by the season, sometimes randomly.  Therefore you cannot assume that a medication or treatment that has been administered for a week or two followed by cessation of headshaking signs is due to the medication.  The improvement in headshaking may simply correspond to normal remission associated with seasonal changes.  This fact has created a lot of confusion among horse owners regarding treatments that “worked” in another horse.

Suggested Program

1. Try various masks and nose covers to see if these help your horse
2. Try supplementing magnesium, keeping in mind the effects of overdose and the need for your veterinarian to monitor your horse's blood magnesium levels
3. Try melatonin and magnesium combined therapy as described on the treatment options page
4. Try cyproheptadine treatment (remember this will test positive at horse events).


Another tool that may help you and your horse is a journal. Keeping a daily journal of your horse's headshaking behavior, diet, activity, and the weather conditions, may help you determine if your horse's condition is seasonal, or is affected by weather patterns.  This information can be useful when creating a treatment plan for your horse.