Cat head shaking, rubbing mouth

My 12 year old female bengal had a couple of teeth removed last year because she was shaking her head and rubbing her chin on things and smacking her lips. However the surgery didn’t resolve the symptoms. The symptoms have continued and she is now seems like she is in pain (hunched, howls, staring into space, pacing).  She has been to vets three times and they can’t see anything physically causing her pain….température normal and urine test was done and all was fine. Any suggestions?please help!!

Hello!  If I think of all of the times in my life when I have been in pain (I am a 40 year old vet with 2 kids, so there have been quite a few), I suspect that my temperature and urine would have been ok for most of them.  I expect that, like your cat, I might simply have walked / stood awkwardly and complained. This might be anthropromorphic, but its also true that many cats arent at their most relaxed in the vets; they be on their guard and try to stand strong when weak spots are poked.  Depressingly this all makes pain in cats very hard to find on examination.

I wonder whether your vet thinks that it is worthwhile blood testing eg for liver disease / pancreatitis (which often doesn't involve vomit) and / or trying pain releif experimentally for a few weeks, in order to test whether or not any change is picked up? Its uncommon to see an obvious response after a single 24 hours treatment because of the potential influence of a vet visit on normal behavoiour.   Definitely worth chatting about.

Another thing to think about is sexualised behaviour eg due to abnormal or normal hormonal change.  This is perhap less likely in speyed females but again, it may be an avenue that your vet wants to explore.

I also wondered whether your cat may be itching; skin allergy and ear disease are in fact very closely linked.  Has your vet seen a video of the behaviour?  This may help them to focus their investigations.

Thank you so much for your kind suggestions, it’s very much appreciated. She is a spayed female …I’m not sure if hormones change as they age (the sure do in humans hihi) We took her to the vets again this morning…ears, gums, teeth, month and full body examination took place. No visual signs of anything whatsoever abnormal. She had a blood test about 12 months ago and all was healthy apart from a slightly raised liver value (but was told it was negligible). I have previously shown the vet a video of her head tremors but without expensive scans they’re at a loss as to what it is. The only area the vet could see some discomfort was the throat ( when it was pressed/poked the cat started the same smacking lips and gulping that she does at home …which is usually accompanied by rubbing her chin on any hard object). She had already been prescribed gabapentin and today has been prescribed matacam as anti inflammatory in addition. Vet suggests jaw/dental X-ray as next step…but obviously that’s a huge expense so we will have to try the medication first. The vet was wonderful but has declared it a mystery as to what’s wrong.

Update. After giving megacam and gaboentin as directed, the cat has been sleeping a lot. But it seems that as soon as medication wears off she’s back to how she was. She seems to be gulping quite a lot. Would you have any thoughts? Thank you so much

Hi again! It’s almost a year later and I’ve been giving my cat the prescribed gabapentin each day…which relieves symptoms while it’s in her system. However the past two weeks it seems to have little affect. She’s back to how she was….rubbing her moth in pain and head tremors. She’s has more teeth out and an X-ray but the vets can’t find anything and believe it’s neurological and without explanation. Has anyone else encountered anything like this ? Please help??!!

Hi - yes, thats a tricky one because its hard to know whether the Gabapentin treated pain or simply made her too sleepy to express it.   I wonder whether a neurological examination could narrow it down to specific cranial nerves, for example?  - as knowing where these nerves run can help to localise disease.  Experimenting with different pain releif may also help, but of course it doesnt say what is causing any pain or how it may progress over time.   There are some vets who practise a scientifically based version of acupuncture (the ABVA, association of veterinay acupuncturists have a list) who may be able to offer to try to treat neuropathic pain.  MRI scans may be helpful in looking for hidden causes.  However these are complex problems because usually until something is found or a change is detected, it can be difficult to promise in advance whether an investigation or treatment trial will lead to anything useful or not.  I wonder whether they can reccommend a referral to someone who specialises in such cases?

The other thing to mention is that smacking of lips and gulping is a sign of nausea in cats, but could potentially also be a sign of a lump or pressure lower down in the throat eg thoracic inlet.  Im sorry that there seem to be many possibilities at this stage, most of the relatively obscure... please will you let us know what happens ultimately?