Impact of Different Diagnostic Procedures on Diagnosis, Therapy, and Outcome in Horses with Headshaking: Recommendations for Fast-Track Advanced Diagnostic and Therapeutic Protocols.
Authors: Kloock Tanja, Hellige Maren, Kloock Anke, Feige Karsten, Niebuhr Tobias
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Diagnostic Protocols for Equine Headshaking Headshaking in horses remains a diagnostic and therapeutic challenge, with most cases attributed to idiopathic trigeminal-mediated disease (i-TMHS) after exclusion of underlying conditions. A retrospective analysis of 240 horses with headshaking revealed that whilst extensive diagnostic investigations (clinical examination, blood work, endoscopy, radiography, CT and MRI) identified numerous findings, only 6% were clinically relevant and associated with secondary headshaking (s-HS) diagnoses—these cases consistently demonstrated positive therapeutic outcomes. Notably, computed tomography of the head identified 9 of 10 clinically relevant findings, whilst other imaging modalities and procedures contributed minimally to clinical decision-making. The authors recommend a streamlined approach: rather than conducting exhaustive diagnostic work-ups, practitioners should use typical history and clinical presentation to identify i-TMHS suspects, then prioritise head CT to rule out secondary causes; when findings are identified, diagnostic anaesthesia or targeted therapeutic trials should verify their clinical relevance before committing to treatment. Adopting this fast-track protocol reduces unnecessary investigations, associated costs, and time to diagnosis whilst maintaining diagnostic accuracy and improving the likelihood of successful outcome for horses with secondary headshaking.
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Practical Takeaways
- •For horses presented with headshaking, prioritize CT imaging of the head rather than conducting extensive multi-modal diagnostics; this identifies the small percentage with treatable secondary causes while reducing cost and time
- •Most headshaking cases are idiopathic and diagnosis is made by exclusion—focus initial investigations (history, clinical signs, physical exam) to determine if CT is warranted rather than pursuing every available diagnostic procedure
- •Horses diagnosed with secondary headshaking based on CT findings have excellent prognoses with targeted therapy, so identifying these cases justifies the imaging investment
Key Findings
- •Among 240 horses with headshaking, only 6% had clinically relevant findings indicating secondary headshaking, with 94% diagnosed with idiopathic trigeminal-mediated headshaking
- •CT of the head revealed 9 out of 10 clinically relevant findings, making it the most diagnostically valuable imaging modality
- •All horses with secondary headshaking (clinically relevant findings) demonstrated positive outcomes after targeted therapy
- •Extensive diagnostic workup revealed many findings but most lacked clinical relevance; focused protocols using CT can reduce unnecessary examinations