Head tilt & balance issues
Head tilt, ‘wry neck’, spinning, hind-end weakness can all be symptoms of EC
How to Care for a Rabbit with Head Tilt
If your rabbit’s head is tilted, they are running in circles or spinning, or they are falling over you need to create a safe enclosure to manage the symptoms and get to a vet ASAP. Your bunny may also be moving their eyes back and forth rapidly (this is called ‘nystagmus’).
Head tilt can progress to running in circles or even full-body spinning quickly. Try to stay calm. There are treatments that can help.
Head tilt in rabbits has several causes, including:
E-cunniculi, or EC. EC is a parasite that attacks a rabbit’s central nervous system. Untreated, EC can lead to death, which is why you should always immediately consult a veterinarian if you see signs of head tilt in your rabbit. Permanent head tilt can result from a bout of EC.
Ear infections. Untreated ear infections can result in temporary or permanent head tilt.
Step 1: Secure your bunny. We recommend putting your bunny in a carrier and using rolled towels to prop them up in a stable position that makes it more difficult for them to spin.
Step 2: Call your vet. Typical causes for head tilt and spinning are e-cunniculi or ear infections. Both are treatable.
Things to ask your vet:
Can we start the treatment for e-cunniculi without doing a blood test? Why you should ask: The blood tests take time and money and aren’t very reliable, and the sooner your start treatment the better.
Does my bunny need extra fluids? Why you should ask: Dizzy bunnies often won’t eat or drink on their own. Ask your vet to show you how to safely give your bunny water and recovery food via an oral syringe. If your bunny needs subcutaneous fluids and might for a while (and you are comfortable with doing some first aid and using needles at home), ask them to train you how to do it.
Do you think this could be an ear infection? Lop-eared rabbits are particularly prone to ear infections, which can be very difficult to get rid of.
Does my bunny also need pain and anti-inflammatory medication like meloxicam (aka metacam)?
You do not have to euthanize a rabbit who has head tilt, dizziness, or spinning. There are very good treatment options. If your vet is not familiar with rabbits, head tilt, ‘wry neck,’ or dizziness and spinning symptoms in rabbits, you can discuss the summary of treatment recommendations at the bottom of this page.
Some things we have done for bunnies in our care include:
Meclizine. This is an over-the-counter anti-motion-sickness treatment for humans often sold in 25 mg pills. We use this to help our bunnies with severe dizziness symptoms. Read more about meclizine for rabbits. Dosage according to Wikiwabbit: 2-12 MG per kilogram of body weight every 8-12 hours. Example for a 6 pound rabbit: 6 lbs = 2.7 kg so the dose range is 5 - 32 mg every 8-12 hours. Generally we split a 25 mg pill into quarters. Each quarter pill is around 6 mg of meclizine. We often crush the pill and add a liquid so we can administer with a syringe.
Femabendazle (Panacur). Panacur is an anti-parasitic. We get panacur from our vet. It is possible to purchase panacur without a prescription online. However, we do not recommend you give your bunny any medicines without consulting your veterinarian. Note that panacur can come in different strengths.
Assisted feeding and fluids. It’s important to make sure your bunny gets nutrition, and many will not eat on their own when they are dizzy. We recommend Critical Care or Sherwood Rabbit Recovery food. Use a syringe to give your rabbit water orally. Ask your vet if your bunny needs subcutaneous fluids.
DON’T GIVE UP. It can take a long time (weeks or sometimes months) to help a bunny recover from dizziness.
e-Cunniculi / EC symptoms can include:
Tilted head
Dizziness or dizzy behavior, including moving in circles
Rapid back-and-forth eye movements that seem involuntary
Head swinging from side to side
Weakness in back legs, falling over, dragging legs
Long-term head tilt
If your rabbit has permanent head tilt, he or she can still live a happy, loving life. At Special Bunny, we’ve helped and loved many bunnies with head tilt, and we want to help you and your rabbit continue to enjoy each other for as long as possible.
To help your head tilt rabbit, you’ll need:
Special care in keeping the ‘down’ eye and ear clean and healthy.
Tips and trick to help with seizures and spinning.
Housing for a rabbit with head tilt
We believe all pet rabbits should live indoors with the family. This is especially true of special needs rabbits.
Some rabbits with mild head tilt continue to be able to use their litter pans.
You can help your rabbit by creating a ‘cut down’ litter pan by:
cutting the side of the litterpan to make it easier for your rabbit to hop into it
creating a ‘litter tray’ instead of a litter pan using a container with very low edges
If your rabbit can no longer use a litter pan or tray, don’t despair!
There are ways to keep your bunny clean and healthy using some very easy to find materials. We’ve created detailed instructions on creating a wonderful living space for your disabled rabbit.
We also recommend that you read this page on Caring for the Critically Ill House Rabbit.
Note that bunnies with head tilt aren’t necessarily critically ill! In many cases, they can go on to live long happy lives even with the head tilt. Also, we strongly recommend adding a layer of faux sheepskin fleece on top of the towels.
AI-generated summary of “treatment protocol for head tilt and e-cunniculi in rabbits.”
This is not veterinary advice. We created this summary to help you talk to your vet about options and appropriate care for your rabbit.
Overview of E. cuniculi
E. cuniculi is a microsporidian parasite that primarily affects the central nervous system and kidneys in rabbits. Common symptoms include head tilt, nystagmus, ataxia, seizures, or kidney issues. Prompt treatment is crucial to reduce the risk of permanent damage.
Treatment Protocol
1. Antiparasitic Therapy
Fenbendazole: This is the most widely recommended treatment for E. cuniculi.
Dosage: 20 mg/kg orally once daily for 28 days.
Notes: Extended courses may be beneficial if clinical signs persist. Fenbendazole has shown efficacy in reducing the parasite load and minimizing CNS damage.
Commercial Product: Panacur or Safe-Guard.
2. Anti-inflammatory Treatment
Meloxicam: Often used to control inflammation, particularly in the CNS.
Dosage: 0.3–1.0 mg/kg orally once daily (higher doses may be required for severe cases, but long-term use should consider GI and renal health).
Notes: Monitor for gastrointestinal side effects and ensure proper hydration.
3. Supportive Care
Prochlorperazine or Meclizine: To manage vestibular symptoms such as dizziness and balance issues.
Dosage: Prochlorperazine: 0.5 mg/kg twice daily or Meclizine: 2 mg/kg once daily.
Nutritional Support: Encourage eating to prevent GI stasis. Syringe-feeding a critical care formula (e.g., Oxbow Critical Care) may be necessary if appetite is reduced.
Fluids: Subcutaneous or IV fluids for hydration and kidney support.
4. Adjunct Therapies
Vitamin E: As an antioxidant to support neural repair.
Dosage: 5–50 IU/kg daily (orally).
Thiamine (Vitamin B1): To support the nervous system.
Dosage: 10 mg/kg subcutaneously or orally every 24 hours.
5. Antibiotics (if secondary infections suspected)
If there are concurrent infections (e.g., otitis media), treat with rabbit-safe antibiotics such as enrofloxacin (10 mg/kg once or twice daily) or trimethoprim-sulfa (30 mg/kg orally every 12 hours).
Monitoring
Regular follow-ups are essential to track neurological improvements or deterioration. Bloodwork (renal panel) is recommended before and during treatment, especially if using meloxicam long-term.
Prognosis
The outcome depends on the severity of clinical signs and how early treatment is initiated. While some rabbits fully recover, others may retain residual head tilt or neurological deficits.
Additional Resources
Textbooks: "Rabbit Medicine and Surgery for Veterinary Nurses" by V. Keeble and A. Meredith.
Online Groups: Veterinarian forums for exotics, such as VIN, are great resources for rabbit-specific cases.
Rabbit-Savvy Consultants: Collaboration with an exotic animal specialist can be invaluable.
Coming soon:
Grooming tips for head tilt rabbits
Managing seizures and spinning.
References from Elaine Bongiorno-Cotta:
The Educated Rabbit (General Info): https://www.theeducatedrabbit.com/head-tilt-in-rabbits.html
The Educated Rabbit (Care): https://www.theeducatedrabbit.com/caring-for-head-tilt-rabbits.html
University of Miami (more academic, but thorough, written by a Ph.D.): https://web.as.miami.edu/hare/tilt.html
VeterinaryPartner (VIN) Head Tilt in Pet Rabbits: https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102922&id=4951372
DisabledRabbits.com (though this unsecure link might scare people): http://www.disabledrabbits.com/head-tilt.html
Animal Emergency & Referral Center of Minnesota (lists what vets can do to diagnose cause of head tilt): https://aercmn.com/head-tilts-in-rabbits-and-rodents/
References from: Gudalewicz Dasha
https://www.unusualpetvets.com.au/wp-content/uploads/2019/11/E-cuniculi.pdf
https://aercmn.com/head-tilts-in-rabbits-and-rodents/
https://www.pdsa.org.uk/pet-help-and-advice/pet-health-hub/symptoms/head-tilt-in-a-rabbit
https://web.as.miami.edu/hare/tilt.html
https://rabbit.org/journal/3-8/head-tilt.html
http://www.disabledrabbits.com/head-tilt.html
https://www.unusualpetvets.com.au/wp-content/uploads/2019/11/Vestibular-Disease-in-Rabbits.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0304401707005997?via%3Dihub
