Welcome to Headshaking Syndrome Center

Headshaking Syndrome Questionnaire

This questionnaire has been developed to collect data for the benefit of all researchers that study headshaking syndrome (HS). It was compiled using research questionnaires from Dr. John E. Madigan and others, literature reviews, and my own observations and conversations with other owners of horses with HS. Your input is greatly valued and you not only help your own horse with your answers but all others as well.
Please feel free to use additional pages or email attachments to add to descriptions. All your input is helpful!

THIS QUESTIONNAIRE IS STRICTLY CONFIDENTIAL

Owner: (optional)

Address:

Phone: E mail:

State: Country:

Horse's name: Age:

Breed: Sex: Coat color

Was your horse imported? When?

What was the month and year of the onset of the headshaking?

What do you think might have triggered the headshaking episode?
What were the initial signs?

Date of purchase of the horse: Previous location:

Current location of the horse:

Describe the current and previous housing conditions and schedule for turnout and care:

Diet current and past (hay and supplements only):

Does his pasture have oak trees, weeds or grass (what kind)?

Is your horse sensitive to wind or fans?

Are there any other headshakers in his vicinity?

Has your horse had any injuries or accidents in the past year? Describe

Does your horse seem prone to skin conditions such as rainrot, hives, etc.?

Vaccination schedule for the past 2 years:

Describe the current level of headshaking (see pain assessment scale

Does the headshaking stop and stop at certain times of the year?
If so, please give details.

Are you able to ride your horse? Under what conditions?

Describe your horse's personality with and without the headshaking:

Behavioral characteristics chart

Please read through this list carefully and for each of the occasions mentioned please tick which sign your horse has shown. (An absence of a tick means the horse has not shown this sign)

Symptoms	When stabled	When grazing	When ridden	After being ridden
Vertical headshaking
Horizontal headshaking
Twisting/rotary headshaking
Odd head carriage
Flipping of top lip/nose
Snorting
Sneezing
Acting like a bee flew up nose
Rubbing nose on objects
Rubbing nose on foreleg
Dropping nose to the ground
Stricking of foreleg onto nose
Stricking out of foreleg
Clamping (shutting) the nostrils
Coughing
Odd/heavy breathing
Sweating? Where?
Nasal discharge Clear, Yellow or White?
Twitching? Where?
Watering eyes
Blinking
Heavy eyelids/dopey expression
Staring in space
Stumbling/In-coordination
Rushing forward/panicking
Unwillingness to move/stopping
Other Behavioural Characteristics

Does you horse crib or have any other vices? Describe:

What diagnostic tests have you had done for diagnosis or treatment options:

Have there been any changes in coat color?

Is jaw or throatlatch swelling observed? When and how long does it last?

Have you noticed labored breathing and/or exercise intolerance? Describe.

Is there any eyelid swelling or eye tearing? Describe.

How does your horse find relief? Does he hang his head low? Seek shade?

Does he display excessive yawning? Describe.

Is your horse sensitive to sunlight? Describe.

Section on Treatment:

Please state details including dosages, length of treatment, short and long term results, administration of treatment, degree of improvement (greatly, minimal or no response), how quick response was, what time of year it was.

Carbamazapine:

(It is especially important to go in detail here):

Steroids:

Fluphenazine:

Chiropractic:

Acupuncture:

Homeopathy:

Herbs:

Melatonin:

Guardian face mask:

Nose net (half or full):

Avoidance of triggers:

Allergy treatment:

Change of bit, tack or rider:

Other methods:

I cannot stress enough that treatments need to be assessed for their ability to work all year without any periods of relapses. Please note any relapses with treatments and how long they remained.

Thank you for your participation!