Head Tilt in Rabbits: Causes, Symptoms and Treatment

Rabbits are known as the ‘masters of disguise’ as they are experts at hiding the signs when unwell. However, a head tilt is one of those dramatic symptoms that is hard to miss. Head tilts can have a wide range of causes and some may be persistent.

While noticing a head tilt in your rabbit can be worrying, many will respond well to therapy. Bringing your bunny to the veterinary clinic promptly can help ensure the best outcome.

What Is Head Tilt in Rabbits?

When we say ‘head tilt’ what we mean is that the rabbit is holding their head to one side at an awkward angle. The technical term for this neck twisting is torticollis.

One analysis of first-opinion clinical records found that 1.6% of rabbits presented with a head tilt in one year, and this value is thought to likely under-represent the true prevalence.

What Causes Head Tilt in Rabbits?

Head tilting is not an uncommon symptom in rabbits. There can be a number of causes.

Ear Infections and Inner Ear Disease

One of the more prevalent causes of rabbit head tilts is an issue with the ear itself. This can mean fungal or bacterial infections but it can also include ear mites or growths within the ear.

Parasites Such as E. cuniculi

Encephalitozoon cuniculi is a relatively common parasite detected in bunnies, although it won’t always cause signs.

As well as resulting in a head tilt, E cuniculi may affect the eyes, kidneys and nervous system.

Neurological and Other Underlying Conditions

When a head tilt occurs, we also have to consider neurological disease such as a bacterial infection of the central nervous system, stroke, or brain tumour.

Other possibilities would include a recent head trauma or toxin exposure.

Data on Rabbit Head Tilts

In a 2024 study published in VetRecord, a diagnosis was reached in only 49.3% of rabbit head tilts. 41.7% of these cases had E. cuniculi, 22% had an ear infection, and the remainder had a combination of both.

What Are the Signs of Head Tilt in Rabbits?

Although the most obvious sign will be the odd position of the head, there are other changes that you’ll notice.

Loss of Balance and Staggering

As the vestibular centre is affected, your rabbit may act like they are drunk or dizzy. They can find it hard to stay upright and walk in a straight line.

Rolling, Circling or Abnormal Eye Movements

Some rabbits will walk continually in circles in one direction, while others may roll. As well as this, you may notice the eyes flickering back and forth, a movement known as nystagmus.

Other Common Symptoms to Watch For

Rabbits with a head tilt commonly feel anxious and may shake, hide away and eat less. They might pass less droppings and become lethargic, and there is even a risk of them developing gut stasis.

Is Head Tilt in Rabbits an Emergency?

A head tilt is always a sign that there is something abnormal going on, and veterinary care is required.

When Symptoms Suggest a Serious Underlying Condition

Call an emergency vet right away if the rabbit:

• Is distressed or constantly rolling/circling
• If they have stopped eating or passing poop
• If there is concern for recent trauma or toxicity

When to Contact a Vet Immediately

You should contact a veterinarian urgently if you are concerned your rabbit is in pain, is not coping or has collapsed. Book them in right away if their signs are rapidly worsening.

How Do Vets Diagnose Head Tilt in Rabbits?

Your vet will examine your bunny and may also run some basic tests, in order to establish a diagnosis.

Physical Examination and Ear Assessment

The rabbit will be checked from nose to tail, including an assessment of gut sounds and checking their body temperature.

The ears will be examined both on the inside and outside for any evidence of infection or parasites. An otoscope can be used to look deep within the ear canals. A swab may be taken of any discharge.

Blood Tests and Neurological Evaluation

A neurological exam is performed in order to assess general nerve function and to check for any defects when it comes to vision, balance and coordination.

Haematology and biochemistry blood tests can be helpful when it comes to checking organ health, ruling infections in and out, and checking for evidence of inflammation.

An antibody assay blood test can be performed to check for E. cuniculi but results aren’t definitive as over 50% of healthy rabbits will have antibodies present. It can be useful to repeat the blood test after several weeks to see if levels have risen.

Imaging and Further Diagnostic Testing

Your vet may discuss further tests, including an X-ray of the skull and ears. In some cases, a CT or MRI scan may be advised, as they are more sensitive when it comes to detecting issues of the middle ear, inner ear, and brain.

A urine analysis may be performed too, and E cuniculi can be detected in a urine sample.

How Is Head Tilt in Rabbits Treated?

The priority will be ensuring your rabbit is comfortable, and the aim will be to cure the head tilt when possible.

Treatment for Infections and Parasites

Any specific infections or infestations will be treated with medicine such as antibiotics or Fenbendazole (a broad spectrum anthelminthic that can stop E cuniculi from multiplying).

Supportive Care and Symptom Management

The environment may need to be modified by using deeper bedding and padding walls, to avoid injuries. Rabbits will need to be kept off furniture and steps or stairs due to the high risk of falling.

Some rabbits can eat well but others require assistance, which may mean hand or syringe feeding.

Many bunnies struggle with hygiene and will need assistance when it comes to grooming and removing caecotrophs from their bottom.

Long-Term Care and Recovery Outlook

The outlook does depend on the cause of a head tilt. An ear infection that is treated promptly may be cured and it is possible for the head tilt to disappear.

For many, recovery is protracted, taking many months. For more severe head tilts, the rabbit may never fully recover.

Can Head Tilt in Rabbits Be Prevented?

Not every head tilt is preventable, but certain factors can help limit risks.

Hygiene and Living Conditions

Good hygiene is essential when it comes to preventing infections and parasites. This includes regular changing of bedding and cleaning away droppings and uneaten food promptly.

Keeping ears clean and dry can lower the risk of infections. Bleach can be used to kill E. cuniculi in the environment.

Early Detection

Treating the head tilt when it is mild carries a much better prognosis of full recovery.

In the case of E. cuniculi it is advised to start 4 weeks of Fenbendazole if there is any concern for infection as this is well tolerated and can effectively stop symptoms from progressing.

Reducing Risk Factors in Rabbits

It is sensible to isolate a new rabbit for 2-4 weeks before introducing them to the rest of the colony, in case they are harbouring any disease.

Rabbits should be routinely vaccinated against Myxomatosis and Viral Haemorrhagic Disease (VHD).

Keep any toxins well away from your bunny, including human medicine, pesticides, and lead paint.

Get Veterinary Advice for Your Rabbit

Contact us for advice if you are concerned your rabbit could be developing a head tilt or you suspect they have been exposed to E. cuniculi or a toxin.

Head Tilt in Rabbits: FAQs

What causes head tilt in rabbits?

Some common causes of head tilt include otitis media, otitis interna, E. Cuniculi, strokes and brain tumours.

Can rabbits recover from head tilt?

It is possible for rabbits to recover fully from a head tilt. Early diagnosis and prompt therapy offer the best chance of full resolution of the head tilt.

Is head tilt in rabbits painful?

Although a head tilt can be disorientating and uncomfortable, it is generally not painful for your pet. However, if the rabbit has an ear infection, this does usually cause discomfort.

How is head tilt treated in rabbits?

Treatment of a head tilt depends on the cause and can include antibiotics, anti-inflammatories and supportive care.