Treatment and management
Sadly, idiopathic headshaking isn’t curable, but a number of treatments may be tried in the hope of reducing the problem. Many of these are unproven and lack sound scientific evidence, so take care if you decide to use them and seek advice from your vet. Nose nets, UV masks and ear covers may help, either individually or in combination. Equine-specific contact lenses can be used in cases where corneal sensitivity is considered a trigger factor. Horses who show a positive response to topical, local anaesthetic eye drops gain the most benefit from contact lenses. Your vet may also recommend an intranasal inhaler, especially if endoscopy has indicated inflammation of the nasal passages or upper respiratory tract. Oral antihistamines, steroids or nonsteroidal anti-inflammatory medications (NSAIDs) can have varying degrees of success. Other drug options include carbamazepine and cyproheptadine, though results are variable and often short lived.
Recent scientific research suggests that EquiPENS (Percutaneous electrical stimulation) neuromodulation is showing promise as a minimally invasive procedure. Its aim is to reset the threshold level for nerve firing to normal and normalise the facial sensations experienced. The procedure involves placing a probe directly over the nerve and stimulating it for a set period. Current research indicates that 50% of horses treated have benefited.
In idiopathic cases that have shown no signs of improvement to any of the above measures and procedures, there are two options — euthanasia or surgery. Caudal compression of the infraorbital nerve can improve clinical signs in more than 50% of cases. However, reoccurrences and postoperative complications may occur.