Investigation & treatment of trigeminal-mediated headshakers at the B&W Equine Referral Hospital conducted by world leading expert and European and RCVS Specialist in Equine Internal Medicine, Dr. Veronica Roberts MA(Oxon) MA VetMB (Cantab) PhD PGCert(HE) DipECEIM FRCVS
Investigation of headshaking at the B&W Equine Hospital
There are many possible reasons why your horse is headshaking. It is really important that we make the right diagnosis so that we can make the right treatment plan. We take a thorough and detailed approach to investigation with a minimum set series of tests to give us the best chance of finding the cause and doing the right thing for your horse.
We work with Veronica Roberts FRCVS from the University of Bristol who is world-leading in headshaking research, making sure we stay right at the top of this field. We see cases with Veronica from all over the UK and she frequently consults on cases worldwide.
Before you come
We will ask you to bring, or send ahead, videos of your horse showing headshaking signs. These can be just 1 or 2 minutes long each (to allow for ease of file transfer). Film when your horse’s signs are typical for him or her. Signs are often worst when in trot but this will vary between individuals. Please include videos taken when:
- Ridden, both in an arena and out hacking but only if safe to do so
- On the lunge (or loose schooled if your horse doesn’t like lunging) just on a headcollar
- On the lunge with side reins, Pessoa or similar
- At rest if headshaking occurs at rest
If you have a clip of your horse being ridden before he or she developed headshaking, then this can be useful.
Please stop any supplements containing magnesium for 7 days prior to your appointment, as we will be running some blood tests. They can be started again once your horse goes home.
Nose-nets and facemasks
If you have not already, it can be useful to try a nose-net at home and report to us, your horse’s response. We recommend trying a competition-legal nose-net, one that is shaped more like a nose-bag and then which has a plate of rigid material over the nose. Please also try a facemask. You should know quite quickly whether these help not at all, make things worse, improve signs enough for your horse’s job or improve signs but insufficiently. Try not to spend too much money on these tests – nets can often be sourced free of charge or second hand from internet horse owner groups.
What to bring with you
Please bring your horse’s tack, boots/bandages and if you are able to be present for the investigation, your own riding clothes and helmet. We usually only lunge horses during this investigation but sometimes we will ask to see ridden work.
At the appointment
You can arrive in the morning or drop off the evening or weekend before, depending on what suits you and your horse best. Subject to radiation and Covid restrictions, you are welcome to join us for the investigations. We plan to run the required tests all on one day. Sometimes it will take us longer, especially if your horse is a bit nervous or has already travelled a long way.
We will start with finding out more about your horse from you, even though we will have already spoken to your vet. As part of this process, we will fill out a standard history form. Some of the questions will seem silly or irrelevant for your horse’s case, but all the data can be fed into research studies (with your permission) to help us to understand more about headshaking.
We will then watch the videos if we have not done so already and then watch your horse on the lunge. If your horse is headshaking consistently on the day, then we will discuss with you whether or not to perform a nerve block which can help show whether or not headshaking is occurring due to facial
pain. We will make this decision with you. We will do a full clinical examination, preliminary ophthalmic examination and oral examination with oroscopy (a camera to best view the mouth cavity). We will run a blood test and test a urine sample. We will do endoscopy of the upper respiratory tract and guttural pouches and a computed tomography (CT) scan of the head.
We will discuss your horse’s diagnosis with you and make a plan together. The majority of horses (90%) which present with a most likely diagnosis of trigeminal-mediated headshaking will have this diagnosis confirmed. For these cases, there is another information sheet available.
The only way to improve treatment for headshaking is to further research in it. We are running some research projects with the University of Bristol. Usually this will only involve access to your horse’s case notes. Sometimes, we will ask that we can enroll your horse in a study and in those cases we will discuss with you directly and have a specific consent form. You do not have to involve your horse in a study if you do not wish to do so.
We would like to take this opportunity to tell you about the Nodding Neddies Campaign, which sells lovely gifts in aid of the University of Bristol’s Langford Trust Headshaking Research Fund https://www. facebook.com/Nodding-Neddies-111641927304045/
Veronica has recorded two presentations on investigation and treatment of trigeminal-mediated headshaking. They have lots of videos and thorough explanation. They are available on our YouTube channel (see below), together with a Case Study.
The standard investigation is covered by a fixed price, so you know what to expect. In a small number of horses we need to run further tests and if so, we will discuss these and their cost implications with you.
We hope this helps you to understand what to expect but if you have any queries then please contact the hospital on 01453 811867 or firstname.lastname@example.org and one of our vets will be happy to talk to you.