Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies.
Abstract: Trigeminal-mediated headshaking is a little-understood neuropathic facial pain condition of the horse. The condition may affect around 1% of the equine population to a degree of severity sufficient to require veterinary attention. As a pain condition, this represents a significant welfare issue. Horses are usually more severely affected at exercise which can leave them unable to perform, or even dangerous to ride and handle. With little known about the condition and variable response to treatments, severely affected horses are often euthanized. This review article considers the literature on trigeminal-mediated headshaking, focusing on what is known, and indeed not known, about the prevalence of the condition and its impact. The current published management options are considered, along with their challenges and limitations.
Publication Date: 2019-01-09 PubMed ID: 30666296PubMed Central: PMC6330979DOI: 10.2147/VMRR.S163805Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
- Review
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research article looks into the issue of trigeminal-mediated headshaking in horses, which is poorly understood yet may affect up to 1% of equines severely enough to warrant veterinary care. Despite its serious implications, including hampering performance and rendering horses potentially dangerous, scant knowledge about it and inconsistent treatment responses often lead to euthanization. The paper reviews current literature on the topic, focusing on its prevalence, impact, and management strategies.
Trigeminal-Mediated Headshaking in Horses
- This research delves into a specific problem that affects horses called trigeminal-mediated headshaking. The ailment is classified as a neuropathic facial pain condition that affects horses.
- The condition is not well-understood in the equine community, and as such poses a serious problem since it affects approximately 1% of horses in a severe manner, prompting veterinary intervention.
- As it is a pain-related issue, trigeminal-mediated headshaking is a significant welfare concern. Impaired performance during exercise and unpredictable behavior, such that horses may become dangerous to ride or handle, are among its side effects.
Prevalence and Impact of the Condition
- The researchers look at existing literature to find out more about the prevalence of trigeminal-mediated headshaking. For now, it is estimated that it may affect as many as 1% of horses worldwide.
- The impact of the condition is severe, impacting the horse’s performance and behavior, as well as their life expectancy. The pain is usually more severe during physical activities. In extreme cases, the severeness of the condition and the horse’s consequential unpredictable actions may necessitate euthanasia, which is a grave welfare concern.
Treatment and Management Challenges
- Given the limited foundational knowledge about the disease and the sporadic response to various treatments, managing and curing trigeminal-mediated headshaking are notably difficult.
- Published procedures for handling the problem are examined, including the difficulties and restrictions associated with these techniques. The paper implies that finding a dependable solution requires further research on understanding the disease and how it manifests in horses.
Cite This Article
APA
Roberts V.
(2019).
Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies.
Vet Med (Auckl), 10, 1-8.
https://doi.org/10.2147/VMRR.S163805 Publication
Researcher Affiliations
- Bristol Vet School, Faculty of Health Sciences, University of Bristol, Langford, North Somerset BS40 5HB, UK, veronica.roberts@bristol.ac.uk.
Conflict of Interest Statement
Disclosure The author reports no conflicts of interest in this work.
References
This article includes 35 references
- Pickles K, Madigan J, Aleman M. Idiopathic headshaking: is it still idiopathic?. Vet J 2014 Jul;201(1):21-30.
- Lane JG, Mair TS. Observations on headshaking in the horse.. Equine Vet J 1987 Jul;19(4):331-6.
- Moore LA, Johnson PJ, Messer NT, Kline KL, Crump LM, Knibb JR. Management of headshaking in three horses by treatment for protozoal myeloencephalitis.. Vet Rec 1997 Sep 13;141(11):264-7.
- Fiske-Jackson AR, Pollock PJ, Witte TH, Woolford L, Perkins JD. Fungal sinusitis resulting in suspected trigeminal neuropathy as a cause of headshaking in five horses.. Equine Vet Educ 2012;24(3):126–133.
- Madigan JE, Bell SA. Owner survey of headshaking in horses.. J Am Vet Med Assoc 2001 Aug 1;219(3):334-7.
- Newton SA, Knottenbelt DC, Eldridge PR. Headshaking in horses: possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases.. Equine Vet J 2000 May;32(3):208-16.
- Mills DS, Cook S, Taylor K, Jones B. Analysis of the variations in clinical signs shown by 254 cases of equine headshaking.. Vet Rec 2002 Feb 23;150(8):236-40.
- Williams WL. Involuntary twitching of the head relieved by trifacial neurectomy.. J Comp Med Vet Arch 1897;18:426–428.
- Williams WL. Involuntary shaking of the head and its treatment by trifacial neurectomy.. Am Vet Rev 1899;23:321–326.
- Aleman M, Williams DC, Brosnan RJ, Nieto JE, Pickles KJ, Berger J, Lecouteur RA, Holliday TA, Madigan JE. Sensory nerve conduction and somatosensory evoked potentials of the trigeminal nerve in horses with idiopathic headshaking.. J Vet Intern Med 2013 Nov-Dec;27(6):1571-80.
- Aleman M, Rhodes D, Williams DC, Guedes A, Madigan JE. Sensory evoked potentials of the trigeminal nerve for the diagnosis of idiopathic headshaking in a horse.. J Vet Intern Med 2014 Jan-Feb;28(1):250-3.
- Aleman M, Pickles KJ, Simonek G, Madigan JE. Latent equine herpesvirus-1 in trigeminal ganglia and equine idiopathic headshaking.. J Vet Intern Med 2012 Jan-Feb;26(1):192-4.
- Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis.. Brain 2001 Dec;124(Pt 12):2347-60.
- Roberts VL, Fews D, McNamara JM, Love S. Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking.. Front Vet Sci 2017;4:72.
- Ross SE, Murray JK, Roberts VLH. Prevalence of headshaking within the equine population in the UK.. Equine Vet J 2018 Jan;50(1):73-78.
- Mair TS. Assessment of bilateral infra-orbital nerve blockade and bilateral infra-orbital neurectomy in the investigation and treatment of idiopathic headshaking.. Equine Vet J 1999 May;31(3):262-4.
- Dermanovic Dobrota V, Hrabac P, Skegro D, Smiljanic R, Dobrota S, Prkacin I, Brkljacic N, Peros K, Tomic M, Lukinovic-Skudar V, Basic Kes V. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes.. Health Qual Life Outcomes 2014 Dec 3;12:171.
- Talbot WA, Pinchbeck GL, Knottenbelt DC, Graham H, McKane SA. A randomised, blinded, crossover study to assess the efficacy of a feed supplement in alleviating the clinical signs of headshaking in 32 horses.. Equine Vet J 2013 May;45(3):293-7.
- Roberts V. Idiopathic headshaking: is it still idiopathic?. Vet J 2014 Jul;201(1):7-8.
- Zakrzewska JM, Linskey ME. Trigeminal neuralgia.. BMJ Clin Evid 2014 Oct 6;2014.
- Devereux S. Electroacupuncture as an additional treatment for head-shaking in six horses.. Equine Vet Educ 2017;27:1–10.
- Roberts VL, Patel NK, Tremaine WH. Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses.. Equine Vet J 2016 Mar;48(2):201-4.
- Pickles KJ, Berger J, Davies R, Roser J, Madigan JE. Use of a gonadotrophin-releasing hormone vaccine in headshaking horses.. Vet Rec 2011 Jan 8;168(1):19.
- Fornasari D. Pharmacotherapy for Neuropathic Pain: A Review.. Pain Ther 2017 Dec;6(Suppl 1):25-33.
- Davis JL, Posner LP, Elce Y. Gabapentin for the treatment of neuropathic pain in a pregnant horse.. J Am Vet Med Assoc 2007 Sep 1;231(5):755-8.
- Mathie RT, Baitson ES, Hansen L, Elliott MF, Hoare J. Homeopathic prescribing for chronic conditions in equine veterinary practice in the UK.. Vet Rec 2010 Feb 20;166(8):234-8.
- Stalin CE, Boydell IP, Pike RE. Treatment of seasonal headshaking in three horses with sodium cromoglycate eye drops.. Vet Rec 2008 Sep 6;163(10):305-6.
- Roberts VL, McKane SA, Williams A, Knottenbelt DC. Caudal compression of the infraorbital nerve: a novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses.. Equine Vet J 2009 Feb;41(2):165-70.
- Roberts VL, Perkins JD, Skärlina E, Gorvy DA, Tremaine WH, Williams A, McKane SA, White I, Knottenbelt DC. Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses.. Equine Vet J 2013 Jan;45(1):107-10.
- Tomlinson JE, Neff P, Boston RC, Aceto H, Nolen-Walston RD. Treatment of idiopathic headshaking in horses with pulsed high-dose dexamethasone.. J Vet Intern Med 2013 Nov-Dec;27(6):1551-4.
- British Equestrian Trade Association National Equestrian Survey. 2015. [Accessed November 30, 2018]. Available from: http://www.beta-uk.org/pages/industry-information/market-information.php.
- . Neuropathic pain in adults: pharmacological management in nonspecialist settings Clinical guideline [CG173]. 2013.
- Slater J. National equine health survey.. 2013.
- World Health Organisation. Guide to identifying the economic consequences of disease and injury.. 2018.
- Dirikolu L, Dafalla A, Ely KJ, Connerly AL, Jones CN, ElkHoly H, Lehner AF, Thompson K, Tobin T. Pharmacokinetics of gabapentin in horses.. J Vet Pharmacol Ther 2008 Apr;31(2):175-7.
Citations
This article has been cited 11 times.- Kloock T, Hellige M, Kloock A, Feige K, Niebuhr T. Impact of Different Diagnostic Procedures on Diagnosis, Therapy, and Outcome in Horses with Headshaking: Recommendations for Fast-Track Advanced Diagnostic and Therapeutic Protocols. Animals (Basel) 2022 Nov 13;12(22).
- Stange LM, Krieter J, Czycholl I. Comparison of the Current Situation of Equine Headshaking Syndrome in France and Switzerland Based on an Online Survey. Animals (Basel) 2022 May 28;12(11).
- Story MR, Haussler KK, Nout-Lomas YS, Aboellail TA, Kawcak CE, Barrett MF, Frisbie DD, McIlwraith CW. Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals (Basel) 2021 Feb 6;11(2).
- Mellor DJ. Mouth Pain in Horses: Physiological Foundations, Behavioural Indices, Welfare Implications, and a Suggested Solution. Animals (Basel) 2020 Mar 29;10(4).
- Heun F, Delarocque J, Feige K, Hellige M. Trigeminal Nerve Asymmetry in Horses With Idiopathic Trigeminal-Mediated Headshaking: A Retrospective Case-Control Magnetic Resonance Imaging Study. J Vet Intern Med 2025 Sep-Oct;39(5):e70196.
- de Preux M, Precht C, Becker R, Stieglitz L, Easley J, Koch C. Navigated minimally invasive puncture of the trigeminal cistern in horses-a cadaveric study in preparation for a controlled rhizotomy. Front Vet Sci 2025;12:1562404.
- Franzen V, Reisbeck D, Leibl Y, Schoster A, May A. Pain Assessment of Horses With Trigeminal-Mediated Headshaking (TMHS) at Rest Between Episodes. J Vet Intern Med 2025 May-Jun;39(3):e70064.
- Franzen V, Gruber NA, Klußmann S, Schoster A, May A. Effect of repetitive transcranial magnetic stimulation on trigeminal-mediated headshaking in 17 horses. J Vet Intern Med 2024 Sep-Oct;38(5):2758-2765.
- Nessler JN, Delarocque J, Kloock T, Twele L, Neudeck S, Meyerhoff N, Riese F, Cavalleri JV, Tipold A, Feige K, Niebuhr T. Sensory nerve conduction stimulus threshold measurements of the infraorbital nerve and its applicability as a diagnostic tool in horses with trigeminal-mediated headshaking. BMC Vet Res 2024 May 16;20(1):201.
- Kloock T, Hellige M, Kloock A, Feige K, Niebuhr T. Application of the HRE-S to 140 horses with trigeminal-mediated headshaking and the association of clinical signs with diagnosis, therapy, and outcome. Front Vet Sci 2024;11:1329054.
- Bell T, Kyriazopoulou P, Mowbray C, Murphy BA. Equine Headshaking Syndrome: Triggers, Seasonality, and Treatment Efficacy in Australia. Animals (Basel) 2024 Mar 13;14(6).
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists