Rabbits come in all shapes and sizes – floppy lop-ears, sticky-up ears and some in-between; but whatever their ears are doing your bunny shouldn’t have a head-tilt.

There are a few different reasons why your rabbit might develop one, some of the causes are more common than others, but all of them require urgent assessment and treatment.

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What signs will you see?

As with any illness in bunnies, the signs can be subtle to start with, and then suddenly progress to being quite dramatic; it’s in their nature to hide things. A head-tilt can occur suddenly, as a result of trauma, for example. However, often the underlying cause has been brewing without our knowledge for days before.

A rabbit with a head-tilt will seem ‘drunk’ and unbalanced. Early signs may be a reluctance to eat or little stumbles/trips when hopping around. In severe cases this can progress to rolling or falling over when attempting to perform any movement. The rabbit’s head will be rotated to either the left or right and they will be unable to straighten it.

They will be particularly unhappy about being picked up as having their feet off the ground and moving will make them feel even more unbalanced. Some rabbits may find this condition very stressful and resent even being touched, which can make management and treatment difficult for them.

Why does it happen?

If a head-tilt develops in any animal you must seek urgent advice from your vet.

Your vet will examine your rabbit and try to work out why it has occurred and what can be done to help. They will ask you questions about what’s happened recently, check your rabbit’s eyes and ears, assess their movement and perform other examinations too. Sometimes it can be very difficult to work out exactly why a rabbit has a head tilt, but there are a few main possible causes:

Encephalitozoon cuniculi (E.cuniculi)

E.cuniculi is a parasite that can live inside a rabbit’s cells and cause damage to the brain, kidneys and/or eyes. It is quite a common parasite in pet rabbits (infecting approximately 50%) but doesn’t always cause an issue. However, in cases of head-tilt it is usually quite high up on the list of suspected causes.

Rabbits that do develop head-tilts as a result of E.cuniculi have often been recently infected with the disease rather than being ‘carriers’ who were infected a while ago. The infection is picked up by either eating or breathing in spores, or transferred by a mother rabbit to offspring during pregnancy.

There is a test available to detect E.cuniculi DNA in urine. However, infected rabbits will not shed the spores all the time and may show up as falsely negative. This means there is no way of 100% knowing whether a head-tilt is due to E.cuniculi, although your vet may have a strong suspicion based on a collection of clinical signs, response to treatment and blood or urine testing.

Treatment is available: a course of treatment to kill the parasite will be prescribed for a minimum of 28 days. This will help to reduce inflammation but sometimes too much damage has already been suffered for a full recovery to ever be achieved.

Middle or inner ear infection

This can happen in any rabbit but is a more common issue in lop-eared rabbits. This is because wax can accumulate at the base of the ears (where they fold over) making them more prone to infection. Infection can then travel into the chambers behind the eardrum (the middle and inner ear) which become inflamed and causing loss of balance and/or head-tilt.

Your vet may recommend imaging (CT-scan or X-ray) to assess for middle/inner ear issues. Medications such as pain relief, anti-inflammatories and antibiotics (if appropriate) may be prescribed.

Trauma

A bang to the head could definitely be responsible. This might be due to a fall or the result of a scrap with another rabbit, for example, and episodes like this should be considered when discussing history with your vet.

Masses/Tumours in the brain

In rare cases, brain tumours can also cause signs such as head-tilt. Other signs may include a loss of balance, change in behaviour and even seizures. Your vet may recommend imaging (such as an MRI scan) to assess the brain for a possible tumour.

Muscle spasm

This is not very common… But pain or spasm in the muscles of the neck can cause your rabbit to be unable to hold its head in a normal position.

Will balance be restored?

This depends partly on whether the cause is treatable/manageable or not; but also on the rabbit’s response to treatment (and sometimes your success at administering it!). Your vet may prescribe a medical treatment to take home, or they may recommend staying at the hospital for treatment.

In some cases, your rabbit may be left with a permanent head-tilt. The brain is very complicated but also amazingly clever and in cases where this happens it is often only cosmetic. Frequently, the brain learns to adjust and allow the rabbit to function in a normal way.

What else can be done to help straighten things out?

Treatment at home can be quite intensive and may require round the clock care:

Help with eating

We all know how important it is for rabbits to eat-digest-poop-repeat… If this cycle is altered in any way then it will be life-threatening. Your rabbit will probably need a little help eating and drinking. This may be raising their bowl up for them, hand-feeding or syringe feeding regularly (every couple of hours).

Companionship

Keep bonded pairs/groups together during treatment unless there is any fighting or strong reason not to do so. A bonded friend helps to lower stress levels in an ill rabbit and will increase the likelihood of a successful and speedy recovery. Think of it as friends/family supporting you if you were poorly.

Eye care

An eye ointment/drop may be needed to help keep the eyes moist, particularly the lower eye (when the head is tilted). This is because it may dry out, causing problems. Speak to your vet for recommendations.

Safe environment

Remove any hazards from the housing area that they may attempt to jump onto, or fall off and injure themselves.

Keeping clean

Make sure litter trays are kept clean – loss of balance means they may miss or trip in them. Clean any urine or dirt from fur to avoid urine scalding or fly-strike.

Time

Remember that any condition will take time to resolve, there are very few immediate fixes.

Unfortunately, sometimes despite everything, there are no treatment options. Occasionally, it may become evident that the rabbit is not responding to treatment or is finding it too stressful. In those cases, it must be considered whether continuing treatment is fair, or whether putting them to sleep may be kinder. Always remember that the sooner treatment can be started the better the chance of a positive outcome.

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