Why is Your Rabbit’s Head Tilted Sideways?

It can happen all of a sudden, or it can happen gradually over time. You wake up to realize that your rabbit’s head is tilted to the side and they can’t seem to stand straight or hop in a straight line. This is a severe condition of a handful of possible illnesses, but in most cases head tilt in rabbits is treatable.

Head tilt usually begins as a symptom of an ear infection or parasitic infestation. While it is a serious condition, it can usually be cured gradually as the underlying cause is treated. Some rabbits never recover from head tilt, but still manage to live happily with the condition.

If you notice any signs of head tilt in your pet rabbit, you should bring them to your rabbit’s veterinarian as soon as possible. The sooner your rabbit is diagnosed and gets treatment, the more likely that they’ll be able to make a full recovery.

What is head tilt?

Head tilt is a condition where the rabbit’s neck is bent to the side and they can no longer straighten their head. So the rabbit will be trying to get up and hop around with a tilted head. If the condition is severe, the rabbit might not be able to get up at all, and may even appear paralyzed. This condition is also called wry neck or Torticollis in the medical community. 

While it may seem like it’s not serious when you just hear about the condition, head tilt can be quite distressing for rabbits and caretakers alike. Rabbits will no longer be able to hop around and enjoy life as easily as they used to. Watching them try and fail to get up and move around freely can be difficult to watch as a caretaker too. 

Because the rabbit’s head is stuck in a bent position, they will usually have a lot of trouble hopping around and balancing. Usually, head tilt is not a condition that will happen on its own but is instead a symptom of a more serious rabbit illness, such as an inner or middle infection. In many cases the rabbit will recover as the infection is treated, but sometimes the head tilt will remain even after the rabbit recovers and will need to be addressed on its own.

Symptoms of head tilt in rabbits

When a rabbit gets head tilt, you will almost always see it alongside other conditions. Since head tilt is a symptom of a number of possible illnesses, you will also see it with symptoms associated with snuffles (read more about snuffles in rabbits) and nervous system-related diseases.

Symptoms that you will commonly find associated with head tilt in rabbits include:

• Tilted head. This can be just a slight tilt or a very obvious bent neck, with the rabbit’s head staying at almost 90º.
• Loss of balance, dizziness, or vertigo. You may notice your rabbit struggling to stand or constantly falling over or rolling over.
• Hopping in circles. If your rabbit is able to hop around, they will go in circles toward the side their head is rotated.
• Seizures. Since head tilt is related to neurological disorders, you may see seizures as a co-occurring condition.
• Paralysis. Sometimes it is true paralysis and sometimes the rabbit just can’t get enough balance and coordination to get up on their feet.
• Eye movement. Heat tilt is associated with a rapid side-to-side eye movement.
• Cold-like symptoms. Head tilt that is the result of a bacterial infection is often caused by an upper respiratory infection that will give your rabbit cold-like symptoms.

Will rabbits die from head tilt?

A lot of the time when rabbits get head tilt, it is because an underlying illness that’s causing it has become serious. For this reason, it’s possible that a rabbit who shows symptoms of head tilt will eventually die due to these other serious conditions. However, it’s typically not the head tilt on its own that results in a rabbit’s death.

It is important to note, however, that many rabbit illnesses that cause head tilt are treatable. These rabbits can eventually recover completely or live otherwise healthy lives even with the head tilt condition.

What causes head tilt?

Head tilt is still not fully understood as a condition in rabbits. We don’t always know why it happens, but it seems to be associated with infections that cause an imbalance within the rabbit’s skull or with neurological issues.

An ear infection or a parasitic infection to the brain or nervous system are the most common causes of head tilt.. However, there are several other causes that need to be taken into consideration. In some cases, the rabbit’s head tilt will recover as the infection clears up. However, the wry neck condition will occasionally persist even after the rabbit has recovered from other symptoms of the illness.

Common illnesses that can cause head tilt include:

• Ear infection. A middle or inner ear infection can cause inflammation in the area that’s responsible for balance. This is one of the most common reasons for head tilt in rabbits. 
• Parasitic infection (e. cuniculi). E. cuniculi is a protozoan parasite that can cause brain damage and paralysis in rabbits. It is generally only a problem in immunocompromised or elderly rabbits, but lives dormant within many healthy rabbits who have been exposed to the parasite.
• Head trauma. If a rabbit hits their head hard, it can trigger brain or neural damage, which can result in head tilt.
• Stroke. A stroke can cause neural damage and cause paralysis on one side of the rabbit’s body or one side of the face, causing it to droop.
• Toxins. If your rabbit ingests something poisonous it can lead to brain damage and head tilt. Ingested lead is one cause that’s been noted as well as the plant called woolly-pod milkweed.
• Cancer. A lump or tumor that develops near the brain or central nervous system can cause head tilt.

Is head tilt contagious?

Head tilt is not contagious, but some of the illnesses that cause head tilt are. E. cuniculi is contagious if rabbits come into contact with each other, but it can also remain dormant for a very long time and not cause any negative symptoms. The bacteria that often cause ear infections are also contagious among rabbits. However, many rabbits will not develop head tilt, even if they become sick with the same bacterial infection.

Other causes of head tilt in rabbits, such as tumors and stroke,  are generally not considered contagious. 

How to treat head tilt

The way head tilt is treated depends entirely on the underlying cause of the condition. You will need to head to your rabbit’s veterinarian for a proper diagnosis and treatment plan. As always, the sooner you can get help for your rabbit, the more likely they will make a speedy recovery.

In general, an inner ear infection will be treated with a round of antibiotics and pain for anti-vertigo medication that you will have to give your rabbit daily. There are also treatments that can be prescribed to effectively combat an infection of e. cuniculi.

Can rabbits recover from head tilt?

Rabbits can and do recover from head tilt. In most cases, as the condition that originally caused head tilt is treated, the rabbit’s head will return to its normal orientation. Even persistent head tilt is usually not permanent. Head tilt that does not go away after the rabbit’s illness has been treated may require some extra medication and therapy.

In rare cases, the head tilt may never go away, but the rabbit will learn how to get around and live a happy life despite their condition. They will have much more difficulty getting around though, so you’ll need to make some changes to their living environment, such as padding the sides of their enclosure and giving them a low-entry litter box.

How long does it take for rabbits to recover from head tilt?

It can take anywhere from 1 week to 3 months for rabbits to fully recover from head tilt. Rabbits who developed the condition as a result of an infection may recover as soon as the infection clears. Other rabbits will live with some level of head tilt for the rest of their lives.

Is physical therapy an option for rabbits with head tilt?

As far as I’m aware, there has not been any research about the effects of physical therapy on rabbits with head tilt. However, many dedicated caretakers have found some techniques that have helped their rabbits recover. Remember, none of these techniques are going to help your rabbit heal overnight. It may take many weeks or even months of working with them before your rabbit is able to recover and get around on their own again.

1. Balance therapy

For this technique, the idea is to gently rock your rabbit back and forth to help them learn how to regain their balance. 

1. Use a laundry basket and place a piece of carpet or rug on the bottom so their feet have traction.
2. Place your rabbit in the basket and make sure they are comfortable.
3. Pick up the basket and slowly rotate it to one side. Wait for your rabbit to regain their balance.
4. Then slowly rotate the basket toward their other side. Wait for them to regain their balance.
5. Repeat this process for 10 minutes twice a day. As your rabbit gets better at rebalancing, you can rotate the basket more quickly and in different directions.
6. You can stop the daily practice once your rabbit can easily hop around on their own, without getting dizzy or falling over.

2. A heating pad

Head tilt can be very strenuous for the neck muscles of a rabbit, so applying heat to this area can help to loosen the muscles and provide relief to any sore feelings. 

1. Heat up a small heating pad. Make sure it’s warm and not hot, you don’t want to burn your rabbit.
2. Pick up your rabbit and make sure they are sitting comfortably in your arms or lap.
3. Loosely wrap the heating pad around the back and sides of your rabbit’s neck (like a travel pillow).
4. After 5-10 minutes remove the bag. Repeat the process once a day until you start to see some recovery for your rabbit.

3. The treat luring method

For rabbits that are highly treat-motivated, you can try to convince them to exercise their neck muscles by luring them with a yummy treat.

1. Get a high-value treat and cut it into small pieces. This will ensure that you’re not feeding your rabbit too many sugary treats.
2. Hold the treat in front of your rabbit’s nose and then lure your rabbit’s head to rotate back into a normal position. Let them follow the treat with their nose.

How long can rabbits live with head tilt?

As long as there are no other conditions present, rabbits can live indefinitely with head tilt. If they have mostly recovered from their illness but still have a slight rotation to their head, most rabbits can eventually figure out how to get around with no problem once or ever. There is no need to put down a rabbit just because they have head tilt, since it’s believed that the condition is not painful for rabbits.

However, if the head tilt is extreme enough that your rabbit is having trouble eating, drinking, or moving around, they will require a lot more support, and may not live as long. Head tilt is definitely disorienting for rabbits and can cause some level of vertigo.

However, since it’s more difficult for rabbits to get around when they have head tilt, it can affect their overall quality of life. It’s always best to take whatever steps you can to treat the condition and make sure your rabbit can stay comfortable at home.

Home care to help rabbits with head tilt

If you are living with a rabbit who has head tilt, you will want to make some changes to their environment to make sure they can stay safe while they are recovering. If your rabbit has an extreme case, you will have to make some major changes to their habitat so they can stay healthy. In less extreme cases, providing extra padding may be enough to keep your rabbit comfortable. 

1. Make sure your rabbit can eat and drink. You may need to give them shallower dishes so your rabbit can more easily reach the food. In some cases, you will need to hand feed your rabbit if they are refusing their food or don’t have a big appetite.
2. The ‘down’ eye may require ointment. Sometimes the rabbit won’t be able to blink the eye that’s closer to the ground and it can get dry and scratched. Contact your veterinarian for advice about ointment and protection for their eye.
3. Pad the sides of their enclosure or pen. Use towels and pillows to pad the sides of your rabbit’s habitat so that they don’t hurt themselves when they get dizzy.
4. In severe cases, provide a smaller, confined space to avoid injury. If your rabbit is struggling to get around and keeps falling and rolling over, give them a smaller space to keep them safe. A large laundry basket padded with towels is good until your rabbit can get around on their own.
5. Provide a low-entry litter box. It’s more difficult for rabbits to hop over things when they have head tilt, so find a litter box that has low sides to help your rabbit get into it more easily.
6. A safe place to exercise. When your rabbit is starting to get around, they’ll be unsteady and have difficulty going in straight lines. Place lots of pillows and blankets around to create padded pathways for your rabbit.
7. A stress-free environment. Helping your rabbit feel safe and loved will give them more confidence and help with a speedy recovery. Make sure there are no loud noises or other household pets (like dogs) around so that your rabbit doesn’t get nervous.

What you can do to prevent head tilt

Since the causes of head tilt are so varied, there is nothing that is going to prevent the condition completely. However, you can reduce the chances of your rabbit developing head tilt by keeping them healthy and stress-free. Many rabbits carry a dormant form of e. cuniculi in their system already, long periods of stress can trigger the parasitic infection. By helping your rabbit feel safe and healthy, you can make it much less likely that your rabbit will ever develop symptoms.

It’s also a good idea to bring your rabbit to the vet if you see any cold-like symptoms. While it may seem like a minor sickness, a rabbit “cold” is actually very dangerous. The upper respiratory infection can eventually spread to an inner ear infection and cause head tilt.

• Learn more: how to reduce stress in rabbits

Sources

1. Ackerman, Sandi. “Head Tilt: Causes and Treatment.” House Rabbit Society. https://rabbit.org/journal/3-8/head-tilt.html.
2. Gavlak, Lawrence. “Physical Therapy for Rabbits with Torticollis (“Head Tilt”).” University of Miami. http://www.bio.miami.edu/hare/tilt_therapy.html
3. “Head Tilt in Rabbits.” Disabled Rabbits. http://www.disabledrabbits.com/head-tilt.html
4. Krempels, Dana Ph.D. “Head Tilt (Torticollis) in Rabbits: Don’t Give Up.” University of Miami. http://www.bio.miami.edu/hare/tilt.html.
5. “Massage.” Disabled Rabbits. http://www.disabledrabbits.com/massage.html.
6. “Why Does My Rabbit Have Head Tilt?” The Center for Avian and Exotic Medicine. https://avianandexoticvets.com/why-does-my-rabbit-have-head-tilt.