Head tilt

Head tilt, also called torticollis, is the rotation of the head of the rabbit sideway. In mild cases, it may not be obvious to notice. In severe cases, the head tilt can also be downwards. Head tilt can be due to a variety of reasons and whilst the underlying cause needs addressing, the rabbit will also require medical and supportive treatment. If your rabbit develops head tilt, contact your veterinarian straight away.

Yes, it is an emergency!

This condition is defined as vestibular syndrome, and it’s due to a change in the animal’s balance. The head tilt can be associated with other problems such as rolling, and it can be quite stressful for the animal.

It is extremely important that if your rabbit develops head tilt, you book an appointment to see your veterinarian straight away. The sooner the problem is treated, the easier it is to get a full recovery.

Rabbits can develop head tilt for many reasons.

The two most common problems are Encephalitozoon cuniculi infection and ear infection. Other less common problems are ear mites, trauma, abscess in the neck area, and other infections due to bacteria such as Pasteurella and parasites such as toxoplasmosis.

Sometimes it is not immediately obvious. It is important to try and get to the cause of the problem, so adjustments or medical and surgical treatment can be implemented to try and resolve the problem and stop it happening again.

The main sign is the rotation of the head to a side. This can be associated to other signs such as:

• Flickering of the eyes (nystagmus).
• Redness of the “down” (conjunctivitis).
• Rolling: this sometimes can be so severe and frequent that stops the animal from moving around and exhibiting normal behaviors. This condition can be very distressing. Soft bedding and rolled towels should be used to prevent trauma.
• Circling and seizures.
• Head shaking and ear scratching.
• Discharge from the nose or history of respiratory problems.
• Redness of the skin of the hind legs and belly (urine scalding).
• Reduced appetite and reduced fecal output: often the rabbit will begin to eat less and less and, if left without treatment, will stop eating altogether. The droppings will become fewer and often smaller and harder, until they too cease production altogether. Rabbits should be taken to the veterinarian if they have not eaten for more than 8-12 h.
• If the rabbit is in pain, they may exhibit a hunched posture, and keep their eyes closed.

Seek veterinary attention as soon as possible! In the meantime, place the rabbit in a quiet area where they can feel secure and support the head with a rolled towel if the head tilt is severe.

Try and provide your veterinarian with as much information as possible.

Your veterinarian will examine your rabbit to identify the cause of the head tilt. They will then suggest further investigations such as a blood test to confirm or rule out E. cuniculi infection and/or radiographs or CT scan to assess the ears.

Some rabbits who have mild signs may be treatable at home, and your veterinarian will give you medication to give to your rabbit. Others may need admitting into the veterinary practice for nursing support.

It is important that rabbits with severe head tilt are supported while the cause is addressed.

To help prevent GI tract stasis (secondary to stress and pain), the rabbit will be given tempting food (freshly picked grass, greens, herbs, etc) and provided with assisted nutrition using a syringe. They will also receive fluid therapy, pain relief, drugs to get their gut moving again, and eye lubricant for the ‘down’ eye.

To prevent rolling, a rolled towel and soft bedding can be used.

If your rabbit lives with another rabbit it is better to try and keep them together. A bonded pair offer each other security and support, and an already ill rabbit is likely to deteriorate if separated from their partner.

However, it can be difficult to determine what one rabbit is eating and who is passing feces when more than one rabbit is kept together. For this reason, it may be necessary to separate the rabbits, but ensure they can still see and smell each other. Placing one inside a large carrier, which is then inside the other rabbit’s environment can often work well.

If the ill rabbit is positive for E. cuniculi, then it is possible that the companion may be affected as well despite not showing any clinical signs. A blood test can detect if the companion rabbit has been exposed to it. In the meantime, a course of treatment should be started. This can either treat the suspected infection or prevent it.

This depends upon the cause and the severity.

Some causes can be short-term and once the underlying cause is corrected, the rabbit should be at no higher risk of further episodes than any other rabbit. In some more severe cases, some animals will stabilize with a persistent head tilt but no circling or rolling.

Much of the clinical improvement relies on the rabbit’s ability to learn to cope with the condition, however episodic worsening may be seen when other conditions or stressors supervene. It is important to try and spot signs at an early stage.