Application of the HRE-S to 140 horses with trigeminal-mediated headshaking and the association of clinical signs with diagnosis, therapy, and outcome.
Authors: Kloock Tanja, Hellige Maren, Kloock Anke, Feige Karsten, Niebuhr Tobias
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: HRE-S Assessment in Trigeminal-Mediated Headshaking Trigeminal-mediated headshaking (TMHS) presents with variable clinical expression across affected horses, ranging from characteristic headshaking patterns and facial pain to nasal irritation and shock-like jerking movements, yet objective assessment tools have been limited. Researchers retrospectively evaluated 140 horses diagnosed with TMHS using the History Rest and Exercise Score (HRE-S)—a standardised assessment protocol that quantifies clinical severity based on historical signs and observations during rest and exercise—comparing findings to existing scoring systems and correlating individual clinical features with treatment approaches and long-term outcomes. The study identified specific associations between the presence and severity of different clinical signs and both diagnostic certainty and therapeutic response, with telephone follow-up providing outcome data for trajectory analysis. For equine professionals managing TMHS cases, these findings provide evidence-based guidance on which clinical indicators carry prognostic weight and may help refine case selection for particular treatment modalities. The HRE-S offers a structured, reproducible framework for documenting TMHS severity objectively, enabling more standardised communication amongst veterinarians, farriers, and rehabilitation specialists involved in managing these often-frustrating cases.
Read the full abstract on PubMed
Practical Takeaways
- •Use the HRE-S as a standardized tool to objectively document headshaking severity, allowing better tracking of treatment response over time
- •Document clinical signs systematically (behavior at rest vs. exercise, facial expressions, nasal irritation) as these patterns help confirm TMHS diagnosis and predict outcomes
- •Video recording and scoring provides objective baseline data for communicating with owners about prognosis and monitoring treatment efficacy
Key Findings
- •The HRE-S scoring system objectively quantifies severity of trigeminal-mediated headshaking across 140 horses with variable clinical presentations
- •Different headshaking patterns, electric shock-like jerking, and nasal irritation signs showed individual associations with diagnosis and treatment response
- •Clinical signs at rest and during exercise were documented and correlated with therapeutic outcomes in affected horses