What you see. The starting point for addressing any equine health related issue is your observation.


Head Tilted or Cocked to Side


Many disease processes can cause a horse to tilt or cock their head. It is classically associated with neurologic (brain) injury or disease, but it can be caused by conditions affecting the inner, middle or external ear, neck injury or pain, or mouth pain. In the case of brain injuries, dysfunction of the vestibular (balance) system causes the horse to establish a new "set point" which is not level. A horse may also tilt its head if a foreign object is lodged in its ears or mouth, or if due to dental issues.

A head tilt is commonly seen in otherwise normal healthy newborn foals, and is thought to result from birthing or uterine position. In this case, it usually resolves within a few days.

  • Code Red

    Call Your Vet Immediately, Even Outside Business Hours
    • If you notice apparent wobbliness or weakness, in addition to this sign.
    • If the results of the Whole Horse Exam (WHE) in the resting horse indicate fever (Temp >101F/38.3C) or heart rate greater than 48 BPM.
  • Code Orange

    Call Your Vet at Their First Available Office Hours
    • If the problem is very mild and does not seem to be causing much harm to the horse.
    • If the results of the Whole Horse Exam (WHE) suggest the horse is otherwise normal.
You also might be observing
Very Common
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your role


What To Do

Assess the horse's general health using the Whole Horse Exam (WHE), paying particular attention to the presence of absence of fever, general attitude and appetite and the ability to walk around normally. Is this behavior associated with eating or not? Offering a small amount of feed tests appetite and the ability to chew and swallow feed.

Assess your horse's ears and mouth using a bright headlight. Look down into the ear canals for ear ticks or a foreign body (often a seed head or piece of hay). If possible to do it safely you might remove the foreign object, resulting in immediate relief and resolution of this problem.

What Not To Do

Do not evaluate or remove foreign objects from your horse's ear if you cannot do it safely, or if it causes your horse undue stress.

your vet's role

Your vet may perform a full physical examination, neurologic exam, ear exam and/or oral exam in trying to determine a cause for this observation. Diagnosis may require additional testing, including radiology and blood work. Your vet will likely want to perform a complete exam on the foal before concluding that the head tilt will likely self-resolve.

NOTE: This observation is associated with Rabies, which is very rare in horses but does occur. As a precaution, wear gloves when handling a horse exhibiting this sign.
Questions Your Vet Might Ask:
  • When did you first notice this problem?
  • Is the horse current on vaccines, including encephalitis, West Nile and Rabies?
  • What is the horse's age, sex, breed and history?
  • Have you been able to look in the horse's ear?
  • Do you notice strange eye movements?
  • How is your horse's attitude and appetite?
  • What are the results of the Whole Horse Exam (WHE)?

Diagnoses Your Vet May Consider

The cause of the problem. These are conditions or ailments that are the cause of the observations you make.

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Treatments Your Vet May Recommend

A way to resolve the condition or diagnosis. Resolving the underlying cause or treating the signs of disease (symptomatic treatment)

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Author: Doug Thal DVM Dipl. ABVP