Headshaking is believed to be due to nerve irritation on a variable level, which can range from increased sensitivity to allergens to overt pain. \u00a0The main nerve that is believed to be involved in the horse is the fifth cranial nerve called the Trigeminal nerve, which is involved with sensation and motor function of the face. \u00a0In some equine studies, headshaking is more associated with specific branches of the Trigeminal nerve including the posterior ethmoidal nerve. Actually, the Trigeminal nerve has three main branches which are the opthalmic, maxillary and mandibular nerve. Headshaking in horses is believed to be closely related to Trigeminal neuralgia in humans, which demonstrates a range of problem from facial pain to migraine headaches.(1)<\/p>\n
What is believed to be occurring is a hypersensitization of the Trigeminal nerve to stimuli, for various reasons. \u00a0In cases of trauma, ear infections, guttural pouch infections or even cases of EPM, the cause of the potential nerve damage is obvious and with resolution of the primary problem, the headshaking often resolves or improves greatly. \u00a0Given the close association of the Trigeminal nerve to the guttural pouch, ear and overall head, damage can occur easily and often secondarily to other problems. In some cases, the nerve sensitivity is associated with allergies such as allergic rhinitis, which may actually explain the seasonality of the condition. \u00a0So, in those cases, we actually have two problems; an allergy and secondary nerve irritation.<\/p>\n
The big issue outside of the known causes, is regarding what causes those ‘idiopathic cases’ in which no known cause can be found?<\/strong><\/p>\n Anxiety and stress are in my opinion, one of the main contributors to idiopathic headshaking. Stress can be increased due to stall confinement, over training, poor diet influences and many other factors. \u00a0Just like in the case of gastric ulcers, stress can be a major contributor to poor health on many levels. \u00a0As stress increases, anxiety becomes a problem and often, just as in the case of humans or pets, an outlet for the pent up energy must be found. \u00a0This is where often negative vices start and include headshaking, weaving, cribbing and pawing. \u00a0In these patients, with routine diagnostics, no problem can be found and the behavior is variable from one instant to the next. \u00a0We may have a horse that headshakes in the stall or cross ties, but when removed from that situation, the problem resolves. \u00a0There may also be the patient that has been stall bound for several months with little to no turnout that develops the problems, but again resolves over time with increased turnout and socialization. The development of these negative vices as a result of stress in the horse is no different than finger nail biting, hair plucking, pacing or other OCD type of conditions in humans or even pets. \u00a0It is a consequence of the environment and a result of anxiety.<\/p>\n So what about those cases that are not associated with anxiety, stress or have an underlying cause such as trauma or infection? The common denominator with the majority of headshakers appears to be involvement of the Trigeminal nerve and increased sensitivity to stimuli, but despite knowing this, the EXACT cause is yet to be determined and likely individual based.<\/p>\n In order to get to the ROOT of the problem, we have to understand what is occurring at a cellular level which may be triggering the increased sensitivity. \u00a0The reality is that inflammation and even oxidative stress are found to be closely connected with headshaking, Trigeminal neuralgia and many other neuropathies in horses and humans.<\/strong> \u00a0In many studies, it has been demonstrated that in cases of neuropathic pain and neuropathic dysfunction, even when caused by trauma or secondary to other health conditions such as diabetes, there is an increased level of pro-inflammatory cytokines including IL-1 beta, IL-6 and TNF-alpha. \u00a0In one study, they not only demonstrated this fact, but also that the cytokines played a major role in the pathogenesis of nerve sensitivity.(2) In other studies, it has been demonstrated that patients with neuropathy have higher levels of free radicals and diminished levels of protective antioxidants. In fact, one study showed that neuralgia patients had lower levels of vitamin C, in which when supplemented, improved spontaneous pain response.(3)<\/p>\n So what is the big deal and what is the connection? \u00a0Is the inflammation the primary problem or secondary? \u00a0We don’t really know the answer to the second question, but when compared to normal, likely the level of inflammation and oxidative stress is reduced. \u00a0What we do know is it is THIS inflammation and oxidative stress, whether if primary or secondary, that is creating nerve damage at a cellular level, leading to decreased normal function and possible increased sensitivity<\/strong>. \u00a0What is the cause of the inflammation and oxidative stress? \u00a0Many causes, ranging from impact of stress to infection to direct trauma. \u00a0The question, when it comes to management, is “are we addressing these issues for maximal outcome?”<\/em><\/p>\n As is the case with many health conditions, we as patients, horse owners or pet owners seemed to fixated on the exact cause, looking for a precise diagnosis. \u00a0In some cases, such as trauma or infection, the exact diagnosis is helpful as it can guide us with therapy. \u00a0However, even with a case of headshaking secondary to EPM, we still have an underlying inflammatory, immune and oxidative stress component. \u00a0If we do not address these, often the success rate with therapy is decreased and relapse rates can be higher.<\/span><\/p>\n Traditional therapies for headshaking mainly include the use of anti-histamines such as Cyproheptadine and in humans, they have used some anti-seizure medications and antidepressants, which have provided some relief but still are lacking in efficacy. \u00a0In horses, Cyproheptadine has been noted to produce results in 70% of patients, but in my experience the results are much lower. \u00a0The anti-histamines are believed to decrease nerve sensitivity to a degree and potentially modulate part of the immune response, but in most, they produce a level of drowsiness and even impact neurotransmitters, which may indeed actually be impacting anxiety and stress levels.<\/p>\n There are many types of antihistamines on the open market currently, and in truth, their level of effectiveness in the horse as a drug class are not very good.\u00a0 Thus, many use antihistamines to rule out allergies as a ’cause’ of headshaking and the results are poor, leading them to exclude allergies as a cause.\u00a0 This is not the case, because, as mentioned, antihistamines are not that effective overall in the horse and even if they were, they are not always effective against allergies or the allergic response, even in people.\u00a0 If they were, then we’d have a cure, right?\u00a0 But…we do not.<\/p>\n The question comes as to what happens in these patients if we attempt to modulate the stress levels, inflammation and oxidative stress?<\/strong><\/p>\n In the study mentioned above, vitamin C supplementation in human patients was noted to decrease nerve pain response. \u00a0The same has also been noted for use of the antioxidants Alpha Lipoic Acid and even Co-Enzyme Q10 in several studies. \u00a0Curcumin has also been shown to provide anti-depressant, pain reducing and nerve protecting properties in many research trials. \u00a0Considering that we have a strong inflammatory component, it begs the question as to what would happen if we controlled it better? \u00a0In some studies, they have investigated the use of steroids and even NSAIDs with varying degrees of results in patients. \u00a0It is true that these medication do impact inflammation, but only on a certain level and not as completely as we would desire. This is where Curcumin, Boswellia, Vitamin C, Vitamin E, CoQ10<\/span> and many others come into play as they impact the inflammatory pathway at a much higher level and reduce those damaging cytokines to a more normal level.<\/p>\n In one study, it was demonstrated that Curcumin changed the course of diabetic neuropathy, through mitigation of inflammation.(4) In another study, it was demonstrated that the concurrent use of vitamin C and vitamin E used together reduced neuropathic pain better than one by itself.(5) The increased results of using two antioxidant together to obtain better results is likely due to the fact that antioxidants themselves become free radicals in the process of neutralization. \u00a0If we use several together, then they can actually recharge one another and minimize this effect. Even Spirulina blue green algae has been shown to have positive effects on reducing nerve sensitivity and being viewed as neuroprotective. (6)<\/p>\n Even when addressing strictly anxiety and stressed induced cases of headshaking, we can look to adaptogenic herbs such as Ashwagandha<\/span>. \u00a0Ashwagandha has been shown in several research trials<\/a> to reduce clinical anxiety and impact of stress by reducing harmful cortisol levels. \u00a0The other added benefit to Ashwagandha is that it has also demonstrated anti-inflammatory and antioxidant properties on the body, which may also account for some of the beneficial results.<\/p>\n A very popular formula for headshaking in the horse is the Cur-OST EQ Green<\/strong><\/span>, as this formula combines many of these nutrients and herbs, along with Curcumin, Boswellia, Spirulina blue green algae and Ashwagandha to detoxify and support nutrition in the horse’s body.<\/p>\n The reality is that headshaking in horses has many possible causes but actually one bottom line, which is inflammatory and oxidative stress damage that is occurring to the nerve cells, leading to increased sensitivity and reactivity. \u00a0The precipitating factor can be trauma, infection, stress, allergies or many others but the bottom line problem is often the same. In reality, we have to ask if we can alleviate symptoms through use of targeted herbal and antioxidant therapy? \u00a0The answer to this question is a simple “yes”, especially when we consider other invasive and potentially harmful options. \u00a0It has been shown in many research trials and demonstrated in active practice.<\/p>\n In my years of clinical experience, we have alleviated about 85% of the symptoms in our patients. \u00a0In many of those cases, we had underlying problems which were resolved, but in the majority, we had ‘idopathic headshakers’ that were often related to stress or other inflammatory problems present within the patient. \u00a0We have managed them and improved them through the use of targeted herbal therapy and antioxidants, strictly. \u00a0Several of those cases failed to respond to traditional modes of therapy, but benefited instead from our approach.<\/p>\n We do not rely on single herbs or antioxidants to impact headshaking, but instead use them together to increase the impact on the patient. \u00a0The three main formulas that we have found success with include our Cur-OST EQ Green<\/strong><\/span><\/a>, <\/span>\u00a0EQ Total Support<\/a> <\/strong><\/span>and addition of the EQ Adapt<\/strong> <\/a><\/span>formula when needed, especially in cases of anxiety<\/a><\/strong><\/span>.<\/p>\n One last thing to note is a TCM or Traditional Chinese Medicine point of view on these conditions, from headshaking to allergies, which are often interconnected.\u00a0 They key here with many of theses cases is to note the time of occurrence during the year.\u00a0 In many, the conditions of allergies and headshaking worsen during the spring and summer.\u00a0 There are two factors here in the environment that are at play, being HEAT and HUMIDITY<\/strong><\/span>.\u00a0 This environmental heat will add to heat already present in the horse, which is heat itself and inflammation.\u00a0 When we add to it, we will bring it to the surface.\u00a0 Thus, many horses will exhibit clinical problems deriving from internal heat, which is worse during those times of the year.\u00a0 Then, we have the humidity factor, which adds to dampness<\/strong><\/span> present already inside of the horse, bringing it to the surface as clinical problems from laminitis to metabolic issues, allergies, headshaking, etc.<\/p>\n Given the above, from a TCM perspective, the solution through diet and herbs would be to ‘cool’ the body of the horse, or dry out the body of the horse, or both, depending on the situation.\u00a0 The Cur-OST EQ Green<\/a><\/strong><\/span> mentioned above does the first, cools the body and quenches the heat component.\u00a0 The Cur-OST EQ Total Support<\/a><\/strong><\/span> would do both, cool and dry out the body to a certain extent.\u00a0 Sometimes more cooling and drying is needed and we have to incorporate other herbal formulas like the Cur-OST EQ Tri-GUT<\/a><\/strong><\/span> or even the Cur-OST EQ IS<\/a> <\/strong><\/span>formula.<\/p>\n![\"Cranial](\"https:\/\/nouvelleresearch.com\/wp-content\/uploads\/2015\/01\/images_TrigeminalNerveHorse-300x218.gif\" "\\"Cranial")
Management of Headshaking in the Horse<\/strong><\/span><\/h3>\n
So, what’s the bottom line?<\/strong> <\/span>\u00a0<\/span><\/h3>\n