TRIGEMINAL HEADSHAKING

Our standard approach is to offer a 1 hour pre-appointment tele-consultation via Zoom. This enables us to obtain as much information about your horses problem as possible and develop what approach is best suited to your horses needs.

During this appointment, ideally we will want to see any video content of your horses behaviour and discuss any treatments or diagnostics you have already tried. 

In some cases, we may conduct this alongside your first appointment in person. The cost of the initial consultation is offset against the cost of your horses assessment. 

In our experience owners have tried many strategies before calling their normal vet, however we may still make recommendations to consider prior to investing in a full investigation of your horses headshaking. 

Such recommendations are made to reduce the financial burden and identify other options you may not have considerd before embarking on further diagnostics. 

We usually request an expert dental evaluation by a veterinary surgeon with a further qualification, and can make recommendations of local practitioners to consider.  This can be combined when assessment is undertaken practices where we consult with you. 

The initial assessment should be undertaken in a setting that is most likely to precipitate headshaking. This may need to consider the weather, location and other triggers, that we will identify during the tele-consultation. This may involve a visit at your horses yard

During the assessment, if the horse reliably is showing signs, we will attempt different nerve blocks to determine the role of trigeminal nerve involvement. It is standard practice to have to place a twitch when placing these needles to prevent injury, but please let us know if you are opposed to the use of a twitch in your horse.

As part of that examination we will also undertake a detailed ophthalmic examination

There is almost no limit to the number of diagnostic tests that can be recommended for headshaking.

Radiographs of your horses head may be valuable to identify subtle dental or bone lesions that have not been identified by an oral examination by a dental expert. 

Endoscopy of the upper airways may be useful to identify boney changes or disease within the guttural pouch.

CT Scan of the horses head can be performed standing in a number of clinics within the UK. It can be useful to identify subtle disorders of the horses head. In one study, CT identified pathology that was likely to be implicated in the cause of headshaking in around 20% of cases, however in the majority these disorders could also have been identified by radiographs (xray). Further some pathologies identified are incidental to the headshaking and resolution of those conditions does not always lead to resolution. As such, we only recommend CT scans in a small number of cases 

Neuromodulation with PENS (Percutaneous electrical nerve stimulation) is the most exciting treatment modality in horses with headshaking. While it does not always fully prevent all signs, it can make horses rideable.

The theory is to try and reduce random electrical impulses from occuring within the trigeminal nerve. We usually undertake 4 treatment, usually on a weekly basis. The procedure is non-invasice and rarely associated with adverse effects, although may occasionally worsen signs initially. In such cases, we usually continue treatment with the combination of medical therapies.

There is debate over different treatment devices. EquiPENS is a specific device that has been evaluated most frequently, but is associated with very high consumable costs and rarely accessible to treatment at home

We use of form of PENS that relies upon consumables with a much lower cost, while delivering that same electical nerve pattern. This considerably reduces treatment costs, so that clients can afford more treatments, which is often required. We have seen good or even better results than when using the alternative since horses can recieve more treatments for the same cost.  We usually perform treatments at home.

Managing horses with headshaking can become very expensive, sometimes several thousand pounds can be spent on diagnostics even before considering treatment. Often insurance limits can be exceeded. 

We will always work with you to identify the most suitable approach considering you, your horse and your budget. 

• Tele-consultation £60 (refunded with full initial assessment)
• Initial assessment £240 
• Nerve blocks £150
• Treatment £1200 for 4 treatments, (includes sedation), although additional visits charges are required
• Other diagnostics will be discussed at the time