Headshaker cases are complex and require a ‘multidisciplinary’ approach including orthopaedic, neurological, ophthalmological, respiratory, and oral assessment.  We are pleased to accept cases for a full headshaking investigation. This involves examination by a team of specialists to identify any underlying neurologic, dental or orthopaedic conditions that may be causing the clinical signs. 

Treatment options

These will depend upon the results of the investigations but may involve joint medication, dental/sinus surgery or medical treatment of allergies and lower airway disease. If a diagnosis of ‘trigeminal neuralgia’ (facial hypersensitivity) is made, this may be treated medically or with EquiPENS™ (pictured). Alternatively, we can also accept cases that have undergone similar assessment at other practices and are suspected to have headshaking caused by trigeminal neuralgia for EquiPENS™ treatment on an outpatient basis.

Examination of headshakers

Horses are examined at rest, on the lunge or ridden, and nerve blocks may be used to help determine the cause of the problem. Diagnostic imaging is often necessary and may include a combination of ultrasonography, radiography, scintigraphy and computed tomography (CT) examinations.  Examinations may additionally include:  

  • Orthopaedic assessment/lameness examination
  • Neurological and ophthalmological examination
  • Upper and lower airway investigations
  • Oral endoscopy

Treatment of headshaking caused by trigeminal neuralgia:

  • Systemic medications
  • EquiPENS™ therapy

EquiPENS™ therapy

EquiPENS therapy

EquiPENS therapy

Rossdales Equine Hospital offers Percutaneous Electrical Nerve Stimulation (PENS) therapy for treatment of the clinical signs of headshaking suspected to be caused by trigeminal neuralgia. This is a new technique that has been shown to alleviate the signs of headshaking in suitably selected cases.

The procedure involves electrical stimulation of the trigeminal nerve at the infra-orbital foramen (see picture) and is performed in the sedated horse, usually with three applications over a 15-day period.

The service is offered in conjunction with Dr Veronica Roberts MRCVS, University of Bristol, who has pioneered this treatment and is leading continuing research into this problematic disease.

If you require any further information about the technique and/or the research that has been undertaken, or you wish to discuss a referral, please email Emily Haggett  or Tim Barnett, or call 01638 577754.