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Understanding Headshaking

Photo courtesy of FLAIR.

Does your horse shake his or her head excessively while under saddle? It is possible that “headshaking” could be the problem! Also known as trigeminal nerve-mediated headshaking, it is a disease that occurs spontaneously and consists of behavior changes such as throwing of the head in horses. Other presentations include snorting, rubbing of the muzzle, and sneezing … all without an apparent cause for the behavior.

There are, however, a long list of other issues that can cause a horse to shake his or her head besides trigeminal nerve-mediated headshaking. Some of these include dental disease, lameness, or even dislike of the bit used on a bridle.

If it is truly “headshaking,” the signs are caused by increased sensation, or a sharp burning pain in a nerve called the trigeminal nerve. The trigeminal nerve is one of many nerves that comes directly from the brain, called cranial nerves. The trigeminal nerve, in particular, exits the horse’s skull near the base of the ear and then travels all the way down to the muzzle. It allows the horse to feel sensation on their face and to contract the muscles used for chewing. Why this nerve becomes painful in horses with this disease is unknown, but it was recently discovered that the nerves are more easily excitable than the trigeminal nerves of normal horses.

Horses may exhibit these signs intermittently or continuously, and they may become worse with exercise. Signs are also seasonal in 60% of affected horses, with them worsening in Spring and early Summer in these cases. Interestingly enough, some horses exhibit headshaking behaviors only when it is sunny out!

Diagnosis of this disease is based on history, observation of the behavior, and elimination of all other potential causes of the head shaking behavior. A thorough physical and lameness exam, endoscopy, and radiographs are some of the many things that should be performed before a diagnosis can truly be made.

Due to our limited knowledge about why the trigeminal nerve is painful and “easily stimulated” in these horses, treatment of the disease can be difficult. Currently, there are no treatments that are completely safe, totally effective, and curative in all horses. Therefore, management of the clinical signs to a tolerable level is the goal for treatment. This makes the disease a “hot topic” of equine veterinary research at many institutions.

Which treatment seems to work the best is quite variable between horses. One of the first treatment methods tried is often a nose net. This is similar to a fly mask but hangs down over the muzzle from the noseband of the bridle. It is speculated that the net causes desensitization of the trigeminal nerve, via constant stimulation applied to that area. Magnesium supplementation is another simple management tool that can be tried in these horses. Magnesium is a mineral that can increase the time it takes for a nerve to become excited, making nerve firing (in this case the trigeminal nerve) less likely. Several medications have been studied and are often tried but have variable success. Since many of the medications used are not legal at horse shows, it is important to check with the governing body of the sport in which you compete before bringing them to a show.

There are also some newer, but more invasive treatment options, such as trigeminal nerve neuromodulation, also known as percutaneous electrical nerve stimulation, that are gaining ground. This procedure refers to physically modifying the electricity within the trigeminal nerve! To do this, electricity is sent through an electrode that is placed around the nerve on the horse’s face. It is thought that this “resets” the nerve into a normal firing pattern. Surgical options have also been reported for this disease, however again had variable results. Therefore, surgery is only tried in cases where medical management has failed.

In severe cases, the increased nerve sensation can be so intense that horses strike at their own nose with their forelimbs or rub their muzzle on stall doors causing trauma. In a small number of horses, the behaviors can become so intense that euthanasia is considered due to constant self-mutilation. On the other hand, some horses with this disease spontaneously go into remission in months or years after first being affected. Miraculously, many of these horses never experience clinical signs again!

Headshaking is a fascinating disease, so it is not surprising that there is ongoing research being done on it all the time. If your horse keeps nodding his head up and down, he is saying “yes, let’s look into this a little further!”

FLAIR: Obligate Nasal Breathing & Respiratory Dysfunction

Woodge Fulton and Captain Jack leap into the Lake while delivering a clear round at their Badminton debut in 2019. Photo by Nico Morgan Media.

When you look at the respiratory system of a horse and human side by side, you may struggle to spot any significant differences at first glance – both include structures such as the nostrils, nasal passages, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli.

However, while our basic respiratory structures and functions may seem to parallel one another, one considerable difference sets us apart from our equine friends: we can breathe through both our nose and mouth while exercising. Horses can’t.

Yes, that’s correct. Horses can’t breathe through their mouth. Strange, right? Referred to as an “obligate nose breather”, a horse’s air intake is strictly confined to their nostrils and nasal passages. But why are horses obligate nose breathers? What’s the difference in anatomy that’s preventing them from using their mouths to breathe?

If you take a closer look at the respiratory tract of a horse, you’d see that the epiglottis (the flap of cartilage located in the throat behind the tongue and in front of the larynx) rests just above the soft palate while the animal is not swallowing. This creates an airtight seal that makes it physically impossible for horses to breathe in through their mouths (unless anatomical abnormalities or pathological conditions are present). To compensate for their lack of mouth breathing during exercise, a horse’s nostrils can flare in order to increase their air intake-but this isn’t the whole story.

As mentioned in our last blog post titled Our Lungs vs. Our Horses’, a horse hard at work can inhale and exhale upwards of 1,400 liters of air every minute with a BPM (breaths per minute) of 140 (this being a conservative estimate). With the sheer amount of air moving into and out of the lungs every minute, you can imagine the sort of stress and strain that a horse’s nasal passages and lungs must endure during exercise. Sure, horses may be built for strenuous work environments, but just like humans, they have physical limits.

Equine Respiratory System

Given that horses are obligate nose breathers, oxygen making its way to the lungs must flow through their nasal passages, down the upper respiratory tract, and into the lungs through a network of tubes: trachea, bronchi, the bronchioles and into the alveoli (or air sacs).

It is Important to note is that the effort needed for the horse to bring the oxygen-containing air into the lungs is greatly increased if there is any reduction in diameter of your horse’s airway-anywhere along the way. As the [unreasonably hard to pronounce] mathematical equation known as Poiseuille’s Law states, any incremental decrease to the radius of a tube increases resistance to flow by sixteen-fold. Simply put, this means that even the slightest narrowing of the airway can result in increased work of breathing. (For more information on Poiseuille’s Law and airway resistance, check out one of our past blog posts, here.) A narrowing of the equine airway can happen when the unsupported soft tissues above the nasal passages collapse inward as the horse inhales deeply and forcefully during exercise which reduces the diameter of the nasal passage. Other airway diameter reductions can happen with respiratory disease conditions such as infections, inflammatory or reactive airway diseases.

But how does increasing the work of breathing affect a horse’s wellbeing? 

When a horse needs to increase its intake of oxygen, it increases the depth and rate of breathing. In addition, blood volume increases by the spleen releasing a reservoir of stored red blood cells, along with increased heart rate and blood pressure.

More blood circulating and higher BPM = problem solved, right? Well, not exactly.

When a horse’s breathing and blood flow increases, there is increased stress on the fragile pulmonary capillary membrane- the site where oxygen exchange occurs between the alveoli and blood vessels. The large increase in blood pressure in conjunction with the strong suction force from the horse’s increased rate and depth of breathing can cause this very fragile membrane to rupture, causing red blood cells to spill into the airways, resulting in exercise induced pulmonary hemorrhaging (EIPH or “lung bleeding”).

Who knew that being an obligate nose breather has such a large impact?

The spring-like action in FLAIR® Equine Nasal Strips gently support the nasal passages, reducing the narrowing of the airways and making it easier for your horse to get all the oxygen they need. By reducing resistance to breathing, the Strips are clinically proven to reduce lung bleeding during high-intensity exercise. For more information on how our FLAIR Strips work, make sure to check out our “Learn” page, here.

Five Reasons to Use FLAIR® Strips in Eventing

Phillip Dutton and Z. Photo by Shannon Brinkman Photography.

1. Health and optimal performance are important for horses at all levels – You may see horses at top levels of competition using FLAIR Strips and think it’s only for them. But, horses in all disciplines and every level of competition need to breathe easy during training and competition so they can perform their best. Oftentimes, lower level horses may not be as fit, may not be in a rigorous training program and may fatigue more easily. So, even though they are not competing at high levels, they are still working hard.

2. Dressage – More people are using Strips during dressage training or warm-ups. Positioning a horse’s head behind the vertical is not natural and increases resistance and stress of breathing. FLAIR Strips are proven to make breathing easier. So, even though FEI doesn’t currently allow Strips during dressage competition doesn’t mean you shouldn’t reduce stress during training.

3. Stadium Jumping – During stadium jumping, horses are holding their breath for at least one third of the round. FLAIR Strips improve breathing efficiency, so horses get the most from each breath when they’re not holding their breath.

4. Cross Country – Galloping and jumping obstacles on a cross country course is one of the most grueling activities a horse is asked to do. Horses are working and breathing extremely hard. FLAIR Strips improve airflow so horses breathe easier. Breathing easier helps reduce fatigue, conserve energy, reduce lung bleeding and improve recovery so horses stay fresh and are ready for tomorrow.

5. Drug-Free and Backed by Science – Developed by veterinarians, FLAIR Strips are self-adhesive nasal strips that support the nasal passages that collapse in all horses during intensive exercise. The Strips are easy to apply and are proven to make breathing easier, reduce fatigue, reduce lung bleeding, conserve energy and quicken recovery.

Webinar on the Amazing Athletic Ability of the Horse to Benefit RRP

Horses perform incredible athletic feats, most of the time while also carrying a rider as they run fast, run for long distances, perform complex movements and more! They are certainly amongst the elite of the animal kingdom. In a webinar this Sunday afternoon at 4 p.m. CST, join Dr. David Marlin, an expert in equine physiology, to explore what makes horses unique from other animals in their athletic abilities.

Tickets to attend the one-hour webinar are $4 USD and all proceeds will be donated to the Retired Racehorse Project. Limited to the first 100 participants, sign-up now here.

You won’t need a science degree to be able to follow this, as Dr. Marlin’s style of presentation is clear and easy to follow. Entertainment and education combined! Flair, LLC and Science Supplements USA are pleased to present this webinar opportunity.

About Dr. David Marlin: As a PhD physiologist and biochemist with over 25 years of experience in academia, equine industry and consulting, Dr. Marlin has authored more than 200 published peer reviewed papers. He has several notable achievements, including working with the Federation Equestre Internationale (FEI), International Olympic Committee (IOC) and as a consultant to the British Equestrian Teams since 1994. Click here for more information.

About Retired Racehorse Project: The Retired Racehorse Project (RRP) is a 501(c)3 charitable organization working to increase demand for off-track Thoroughbreds and build the bridges to second careers. It publishes Off-Track Thoroughbred Magazine, hosts the Thoroughbred Makeover and National Symposium, manages the online Thoroughbred Sport Tracker, and presents programs at major horse expos across the country. Visit the RRP online here.

About Science Supplements USA: The first Science Supplements products were the brainchild of Dr. David Marlin. Committed to supplying the finest quality horse supplements, Science Supplements have key ingredients that have been proven to benefit performance, health and well-being in laboratory, clinical and field trials. Products launched in the UK and other parts of the world in 2014 and are now available in the US and Canada. For more information, contact [email protected]

About Flair, LLC: Flair LLC, maker of FLAIR® Equine Nasal Strips, is dedicated to evidence-based products for health, welfare, and performance of horses; it’s about the horse. Developed by veterinarians, FLAIR Strips are drug-free, self-adhesive nasal strips that support horses’ nasal passages and promote optimum respiratory health of equine athletes at every level of competition. FLAIR Strips are clinically proven to make breathing easier, reduce fatigue, conserve energy, quicken recovery, and reduce lung bleeding. More than eight clinical studies have been conducted on FLAIR Strips at leading equine research centers. For more information about FLAIR Strips, click here.

A Breath of Fresh Air in Horse Health and Performance

Lauren Kieffer and Paramount Importance at the 2019 Land Rover Kentucky Three-Day Event. Photo by Shannon Brinkman Photography.

By the time a horse has gone a sixth of the way around a four-star cross country course, he will have cycled approximately 475 gallons of air into and out of his lungs. To help visualize this: Imagine the average American bathtub “filled with air” and then added five more tubs next to it – that is about how much air a horse will inhale and exhale, which is nearly 10 gallons per second!

Oftentimes when we think of performance horses, our mind paints a picture of a strong bodied steed with well-defined muscles and a bigger stature than the rest. But, beneath the surface lies a crucial factor to a horse’s performance that often goes overlooked: breathing. We never really realize it, but regardless of a horse’s level of competition – amateur or professional performance horses – all work at a high level of intensity. A horse’s respiratory involvement remains invariable across disciplines, being just as important during lower levels of training and competition as in high levels.

Graphic provided by FLAIR Strips.

At the surface, when a horse is hard at work during an event or exercise routine, the unsupported tissues overlying the nasal passages collapse, resulting in less efficient breathing and more strain on the horse before being able to reach its optimal performance. Unlike humans, during intensive exercise horses do not breathe through their mouth and nose. A horse only breathes through its nose because the tissues that separate the nasal passages from the oral cavity are longer. So, when horses inhale during exercise, around 90% of the resistance (obstruction) to air movement is found within the airways of the nostrils, nasal passages, larynx, and trachea. Of this 90%, half of the resistance comes from the nasal passages. This goes to show that the nasal passages of a horse are directly correlated to the efficiency of its air intake and that unobstructed and unrestricted airways make all the difference when it comes to the endurance and high-performance capabilities of your horse.

Developed by veterinarians, FLAIR® Equine Nasal Strips are a drug-free, clinically proven solution that makes air intake easier for horses, resulting in less strain on the horse’s body while allowing them to reach optimal performance more efficiently. Offering gentle and noninvasive support to a horse’s nasal passages, the proprietary adhesive and shape memory support system provides improved airflow to the lungs: reducing fatigue, conserving energy, quickening recovery, and reducing lung bleeding.

Help your horse work hard and breathe easy with FLAIR Equine Nasal Strips.