Headshaking Syndrome Criteria
Headshaking Pain Assessment Scale:
A horse may have a few or
all of these traits

Heashaking syndrome is differentiated from general headshaking by the association of the mandatory symptom and the at least two of the additional symptoms and the occurrence of the symptoms at the same time. This definition will help eliminate searching other causes that do not include the combinations of symptoms.

Mandatory symptom: tic

Vertical up and down (flicking or bobbing) movement of the nose and/or head and neck. Movement is usually acute, violent, intermittent and involuntary. "Acting like a bee flew up nose" (most frequently reported description of headshaking syndrome). More rarely, movement may be horizontal, head slinging or twisting.

Most frequent concurrent symptoms:

Rubbing ears/nose/lips on legs or objects. This may be frantic and excessive to the point of loosing face hair.




Less frequent concurrent symptoms:

Eye tearing, blinking, edema

Nasal discharge

Sunlight sensitivity

Hypersensitive to touch and stimuli

Distracted, distant stare

May have any or all of the above symtoms. This may vary according to the level (pain assessment scale). Usually, headshaking syndrome includes two or more symptoms at the same time.


Level 1
Expression calm and relaxed in all activities..
Level 2
Rubs nose on stall or other objects, sneezes or coughs, stamping, dislikes grooming, may shake head vertically. May be spooky and distracted. May rub nose on legs, even while moving forward.
Level 3
Stares, disconnected from the environment and focused on self, ears twitching, tightens chin, flips nose downward, horizontally or otherwise shakes head 0-2 times in 15 minutes.
Level 4
Sneezes, coughs, slightly agitated, flips nose downward in sudden, extreme movements (approximately 1-5 times in 15 minutes), rubs nose on legs or any other object nearby. May become light sensitive at this point.
Level 5
Entire neck may become involved with up and down vertical and repetitive movements, the horse becomes more agitated, headshaking increases to 5-15 times in 15 minutes. May strike with legs at nose, becomes panicky and either won't move forward or wants to run.
Level 6
More continuous headshaking at 15-30 times a minute. May become extremely panicked and frantic to the point of hurting himself or others around him, headshaking 30 - too numerous to count.

Points in Agreement

I feel at this juncture, after talking to many experts on headshaking syndrome, that there are several factors that we all agree on.

Firstly, that the criteria that I have outlined here is true for all headshaking syndrome horses and that these symptoms are a result of neuropathic pain along the trigeminal nerves. These criteria can be helpful in quickly recognizing headshaking syndrome and differentiating it from other types of normal headshaking.

Secondly, that there are many TRIGGERS, not necessarily causes, that can elicit this type of pain. I think that most would agree that the Trigger Avoidance Method (TAM) that I have outlined in my treatment section would be a method that all headshakers should follow no matter what type of treatment they are receiving.

Thirdly, we need a pain assessment scale in order to evaluate which treatments to use and their efficacy.

Finally, I feel we all agree that the earlier the nerve wind-up is reduced the better the chances are that whatever treatment that you are using will work.

In conclusion, we should get together on the points that we agree on and make them more solid to give us more guidelines.

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