Treatment of idiopathic headshaking in horses with pulsed high-dose dexamethasone

Treatment of idiopathic headshaking in horses is complicated by an incomplete understanding of underlying pathophysiology and partially effective treatments. If an inflammatory etiology exists, corticosteroids could be beneficial.

An anti-inflammatory dose of dexamethasone reduces the signs of idiopathic headshaking in a field setting.

Convenience sample of 20 adult horses with idiopathic headshaking syndrome. Cases were recruited from the general population and diagnosed by attending veterinarians.

Prospective, blinded clinical trial. Pulsed dosing was with oral dexamethasone (60 mg PO Q24h × 4 days, q3 weeks for 4 months) or placebo (inert paste). Owners were blinded and asked to score the headshaking from 0 to 4 (4 = most severe) 3 days per week. The change in headshaking scores (HS) over each treatment pulse was compared between groups by ordinal logistic regression.

Twelve horses completed the trial. There was no significant difference between treated or placebo horses (P = .987). Sun (P ≤ .001), wind (P = .028), and exercise (P ≤ .045) significantly increased HS.

No benefit of dexamethasone treatment was detected for idiopathic headshaking. The results confirmed previous reports of common triggers for headshaking behavior