Headaches and Headshaking in Equine Patients

Owners and riders of horses may, at some point, experience the frustration of not knowing what to do in the event of their horse becoming a “headshaker”. There can be many different reasons for horses to head-shake, and so the most important thing is to work with the Vet and other paraprofessionals to ensure a cause (or likely cause) is found. 

Head-shaking can become dangerous in extreme cases by unbalancing the horse, leading to potential falls, secondary trauma through head impact, or potentially injuring a handler or rider. The causes of headshaking can also create learned behaviors that become very hard to decondition. 

Headshaking 

The presentation of a head-shaker will vary, but many clinical signs are common. Most head shaking will be up and down on the sagittal plane, while some may twist and rotate at the same time. 

Sometimes the actual action of the headshake can help to identify a cause and isolate maintaining factors involved. The action of headshaking is sometimes quite violent and sometimes just a bobbing action; however, even the most light of headshaking will, over time, produce secondary concerns. 

Veterinary attention will seek to rule out other causes before concluding a headache. It is important to remember that headache could arise as a result of another initial cause. Some potential triggers for headshaking could include:

• Mites (in the ear)
• Otitis media/interna/externa (ear infections)
• Ocular conditions
• Guttural pouch infections
• Dental issues 
• Rhinitis 

The list could go on… (Lane and Mair, 1987)

Obvious signs of infection, both clinically observed and through lab testing, would not discount a headache, as pain could be a secondary factor and maintain or exacerbate the head shaking. 

The action of headshaking in horses can often become more noticeable or prevalent during exercise, often showing no signs at rest. There may also be a seasonal difference in symptoms, which may indicate an allergic rhinitis present. Around 60% of headshakers have shown spring/summer seasonal worsening of symptoms (Roberts, 2019). 

Headaches 

There can be a multitude of factors that lead to headache in horses. The type of headache will depend on the pathophysiology of the causes, but various types can lead to headshaking behaviours. 

Potential causes can include:

• Dental issues
• Sinusitis 
• Cervical spine dysfunctions
• Poll issues
• Meningitis 
• Space occupying lesions - Tumours, Abscesses 
• Cranial trauma
• Neuralgia 

Clearly, with some causes, lab testing and veterinary clinical examination can make the definitive diagnosis to allow for treatment. However, sometimes the cause or even causes of the headache can be more elusive, and it may require a process of elimination type approach. 

Headache pain can be worse on exertion, and so horses may react more when ridden or driven. Even a mild headache can affect the horse when under saddle or in work, and this impact can often be misconstrued as a behavioural issue. Of course, no amount of training will fix a headache. 

Central sensitisation 

When we consider the reactions of the horse who is suffering from a headache, they may not seem entirely congruent with a present trigger or obvious trauma/condition. This may be due to the pain sensitivity being “dialed up” internally. Central sensitisation is a state of heightened responsiveness in the central nervous system, which can amplify pain signals. 

There may not be present inflammation or tissue damage, but hyper-excitability of the nervous system can signal the same level of pain as if there were severe trauma. 

The causes are many and complex, and the study of this Nociplastic pain (as it is now often called) is continuous. Hormonal imbalances are sometimes highlighted as a trigger, as are chronic inflammatory states; however, there can be a genetic predisposition or even psychological influences. 

One way to imagine the process taking place is to think of the nervous system like pathways through a dense forest. If someone walks a particular pathway everyday, treading down the plants and clearing the route, then the pathway becomes easier to navigate. If a nociceptive (pain) pathway is continuously stimulated, then this same phenomenon could be responsible for the increased sensitivity. In this sense, it is easy to see how even a rider’s or handler's activities around the horse could lead to sensitivities. 

Osteopathy for Headache and Headshakers 

As discussed in previous articles and is always the case, a proper veterinary diagnosis is essential before we, as Osteopaths, aim to assess and treat. Vets often refer to Osteopaths and other paraprofessionals for this kind of condition, as a multi-disciplined approach is often the best course of action. 

Osteopathic assessment of the horse may be able to isolate a causative factor and maintaining factors within the head and neck, and so treatment may be only regional. However, there may be wider factors that the Osteopath can address. There may be postural concerns that are impacting the horse’s head and neck positioning, these could be a result of spinal restriction, foot and limb balance, or an injury. 

If the horse’s head and neck position is affected to the point of making compensatory patterns, then this could in turn, trigger headache pain. There is also the possibility of jaw alignment or the hyoid apparatus being affected by more distal structures due to large muscle connections with the shoulder and neck. A jaw pain or temporomandibular joint dysfunction could trigger headshaking. 

The key factor in a treatment being Osteopathic is that it is guided by the principles and philosophy of Osteopathic medicine. The body functions as an interconnected unit, therefore, the practitioner who is aware of this may find triggers and causes that seem as though they would be far removed from the symptomology. It is a case of tracking what is found in a logical way to the presenting complaint. 

With the trigeminal nerve being a major factor in a large number of equine headache cases (Newton, Knottenbelt and Eldridge, 2010), the Osteopath may seek to find areas where the path of that nerve is compromised. This perversion of function could be through compression or stretch of the nerve, for example. 

Remember that structure and function are reciprocally interrelated. The compression or malposition of the nerve structure will alter the function, resulting in pain or numbness. Various structures can compromise nerve pathways, including muscle, bone, fluid swelling, and space occupying lesions like tumors. 

If we find that neural pathways are being perverted by muscle tension, then we can apply soft tissue release techniques to alleviate pressure on them. To be complete, however we may want to ask the question “why is this muscle/muscles doing this?”. 

There will be a configuration that requires the muscle to be in this state, our work can then seek to discover why. This configuration could be a postural or traumatic positioning that necessitates it, or it could be environmental, such as horses' feeding position or tack influences. 

While a headache that is caused by temporomandibular joint (TMJ) dysfunction may be treated by articulation of the joints, release of the masseter, temporalis, and pterygoid muscles, the actual reason for the joint dysfunction may be further away. 

It might be that the TMJ dysfunction is caused by stress and subsequent jaw clenching and tooth grinding. This could be found within the case history and questioning when the owner mentions the horse is grazed alone and spends time walking the fence line, and calling. The practitioner may suggest a gradual introduction of a field companion to allow for natural behaviour to flourish and reduce stress. 

What can we do to avoid headshaking? 

There will, of course, be some cases of headache and or headshaking that will be beyond our control to avoid, such as traumatic injury or neoplastic (cancer).

Our role as owners and keepers of horses is to ensure that all possible precautions are taken and that any signs of illness are picked up on as soon as possible. 

Much of the time, it is education and awareness that help to improve horse care and welfare. Many owners are not aware of the intricacies of tack fitting, and of course, professionals train for years to become proficient in this. Some simple checks can help, however. 

• Check the pressure of the bridle at key points of contact such as the poll, nose band (if using one), and around the ears. 
• Ask a professional (saddler or trainer) to help you fit the bridle and ensure that the position of all parts are correct. 
• Check for any sharp or irritating parts of the tack, such as loose stitches, sharp edges, and bulky straps. 
• Try different types of bridle set up and materials to see what suits your horse best. 

If your horse is sensitive to dust and pollen, then you may find that keeping your riding or exercise to times of the day when pollen count or dust is lower is best. You could also investigate the use of nose nets or applying pollen capture gels around their nostrils. Nasal irritation can be a cause for headshaking and so try keeping their nose clean with a soft sponge and clean water to gently clean around the other part of their nostrils. 

It is good practice to regularly get your horse’s teeth checked by a vet or equine dental technician. Remember, however, that only vets can perform certain dental procedures. Some younger or older horses may need checking on more regular intervals, around 6 monthly. Other horses may be able to have their teeth addressed annually. The important thing is to ensure you follow the recommendations from your vet. 

Having a good grooming routine helps you to investigate your horse’s reaction to touch around the head, check for signs of mites or insect bites, and look for any signs of injuries. Some Osteopaths will suggest scanning with your hands when grooming, as you can pick up things like temperature changes or lumps and bumps. This can often find potential causes of headshaking and headache before they become problematic. 

Some owners will keep an equine specific thermometer in their first aid kit, and this can be useful to monitor changes that can occur during infection. Some horses can develop guttural pouch or dental infections, and this can create pain and headshaking. 

If you notice signs of swelling around the jaw or face, then this can also be a sign of infection. Other signs to watch out for are general malaise, feeding problems, dehydration, dull coat, and nasal discharge. 

Conclusion

There can be very serious health concerns causing horses to head shake. All cases should be checked by the vet first to rule out complications that may need urgent medications or surgery. Even when a serious complication is present, the vet may still recommend the help of an Animal Osteopath. As described above, the best way to avoid this from occurring is generally just good horse husbandry and care. Get to know the horses/’s you care for well and you will notice changes in their behaviour and health very easily. 

Bibliography: 

LANE, J.G. and MAIR, T.S. (1987). Observations on headshaking in the horse. Equine Veterinary Journal, 19(4), pp.331–336. doi:https://doi.org/10.1111/j.2042-3306.1987.tb01424.x.

Newton, S.A., Knottenbelt, D.C. and Eldridge, P.R. (2010). Headshaking in horses: possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases. Equine Veterinary Journal, 32(3), pp.208–216. doi:https://doi.org/10.2746/042516400776563617. 

www.sussexequinehospital.co.uk. (2025). Head Shaking. [online] Available at: https://www.sussexequinehospital.co.uk/en-gb/news-events/factsheets/head-shaking [Accessed 8 May 2025].

Roberts, V. (2019). Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies. Veterinary Medicine: Research and Reports, Volume 10, pp.1–8. doi:https://doi.org/10.2147/vmrr.s163805.

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