Rabbit head tilt: causes and treatment

Head tilt (torticollis) in a rabbit — where the head is persistently held at an angle, sometimes dramatically so — is alarming to witness, but it is often treatable. The cause determines the outcome.

The three main causes

1. Encephalitozoon cuniculi (E. cuniculi)

The most common cause of head tilt in rabbits. A microscopic parasite (Encephalitozoon cuniculi) that lives in the nervous system and kidneys of many apparently healthy rabbits. When the immune system is stressed or the parasite burden increases, it causes inflammation in the brain and inner ear, resulting in:
- Head tilt (mild to severe — some rabbits roll uncontrollably)
- Loss of balance, rolling, falling to one side
- Nystagmus (rapid involuntary eye movements)
- Rear leg weakness or paralysis
- Urinary incontinence

Blood test (E. cuniculi titre) can indicate exposure, though not active disease. Treatment: fenbendazole (panacur) for 28 days is the standard protocol, alongside anti-inflammatory medication (meloxicam). Many rabbits improve significantly, though some residual tilt may remain.

2. Inner ear infection (otitis media/interna)

Bacterial infection of the middle or inner ear. Signs are similar to E. cuniculi. The vet will examine the ear canal and may recommend skull X-rays or CT scan to assess the extent. Treatment: prolonged antibiotic course (weeks to months). Sometimes requires surgery if there is significant pus accumulation (bulla osteotomy).

3. Stroke / vascular accident

Less common but occurs. Sudden onset of rolling and head tilt; the rabbit may improve rapidly over hours to days if it is a cerebrovascular event, or deteriorate if it is a haemorrhage.

Other causes: trauma, brain tumour, vestibular disease, toxin exposure

What to do immediately

A rabbit with a new head tilt needs a vet assessment the same day. In the meantime:
- Provide a padded enclosure to prevent injury from rolling
- Ensure access to water and food — hand-feed if necessary
- Do not leave unsupervised with other rabbits (they may be bullied while vulnerable)

The outlook

Most rabbits with E. cuniculi-related tilt improve with treatment and adapt remarkably well to a persistent mild tilt. Do not euthanise prematurely — many rabbits with head tilt continue to eat, hop, and have excellent quality of life.