The most common causes of headtilt are:
1) EC (E Cuniculi / Encephalitozoon Cuniculi), which is a parasite
2) A bacterial infection (often Pasteurella, gennerally showing as an inner ear infection).
Panacur is the best meds for EC – it is an antiparasitic/wormer. Make sure your bunny is on a 28-day course (minimum!). A lot of vets prescribe for just 5 or 10 days, but it is important to treat for a full course in the case of headtilt.
For a bacterial infection / inner ear infection / Pasteurella, your bunny needs a long course of antibiotics. Baytril (the general rabbit antibiotic) is sometimes strong enough to help a mild case of headtilt, but most of the time a stronger antibiotic is needed. From experience with my Lara the headtilt bun I strongly recommend Zithromax (Azithromycin). Not many vets use this, but it has an excellent reputation at my rabbit-specialist vet practice. Alternatively, you could give Baytril injections alongside Penicillin injections daily. We tried this with Lara and it did help, but Zithromax was definitely the best medicine for Lara. In some parts of the world (anywhere but the UK?) Bicillin is available, which has proven to be effective in a lot of bacterial issues when given regularly at a high enough dosage.
Note: It is very difficult to rule out either EC or bacterial infection/Pasteurella so it is best to treat for both. In an ideal world we would be able to obtain absolute certainty over the cause(s) of each headtilt case and treat accordingly, to avoid giving meds unnecessarily. However, this is often not possible due to time or financial constraints. This debate will be discussed further soon!
Other possible causes
There are other causes of headtilt too that are less common. Have a look at the following links for more details.
Although I’m not sure there’s scientific proof that they work, I personally swear by probiotics! They are particularly important if your bunny is on antibiotics.
I currently recommend AviPro Plus. My bunnies like the taste of this, so I can sprinkle it on their pellets. However, this could be more difficult with a headtilt bun, so it would be better to mix it with water and syringe feed or add it to their syringe food. You can add probiotics to their general water, but it’s difficult to know then how much they are taking in.
Another probiotic often used by vets is Bio-Lapis Protexin.
Alongside these medicines you need an anti-inflammatory – either Metacam (a non-steroidal anti-inflammatory) or steroid injections (max 3 injections, with 2-3 days between each dose). Do not give both Metacam and steroids together.
The anti-inflammatories can help with balance – they can sometimes stop the spinning/rolling of severe headtilt. If your rabbit is spinning/rolling, or curling up and falling over a lot, then talk to your vet about administering steroid injections. If your bunny isn’t as bad as this, or has already had a course of steroids, then ask your vet for Metacam (oral, daily). One or the other is essential.
[NB some people say that a course of steroids at the beginning of headtilt symptoms can prevent damage during headtilt – therefore stopping the bunny reaching the spinning/rolling stage. I have not yet seen evidence of this, but cannot rule out the possibility. I always wonder if my Lara would have bypassed the severe headtilt stage if she’d had more aggressive treatment at the start!]
Please note that the use of steroids is controversial. Some vets refuse to administer steroids at all because they do carry risks (e.g. their effect on the immune system). However, used appropriately and with caution it is in some cases worth those risks. This is another point that will be debated further soon.
Food and drink
These are medicines just like the anti-parasitics and antibiotics! Make sure your bunny is getting enough food and water. If they don’t get enough of either then this will make them weak, and unable to fight the illness. Food and water = strength.
See Food and Drink – the essentials in the left-hand menu here for some tips.
Other than these main things, your bunny needs lots of cuddles and reassurance 🙂 Gentle massages around the head, neck, back and sides can help relieve tension that builds up from the twisted position they often end up in.
Cuddle times can help your bunny begin to trust you again too. So often with headtilt, you constantly have to administer meds, encourage them to eat and drink, clean them up, etc. All this adds up to the bunny feeling poked and prodded and miserable. They often then come to expect you to be doing something annoying every time you go near them – which doesn’t help their patience! So introduce cuddle times too. A gentle massage can be a great reward for when they’ve had their meds or eaten some food, but set aside just a few minutes as often as you can to just go to them for a cuddle. It works wonders 🙂
Some basic safety tips for your bunny enclosure
Provide your bunny with lots of objects to lean against – rolled up towels, cushions/pillows, or bunny-safe toys. Protect them from hurting themselves on hard flooring or sharp corners (remember their eyes are at funny angles, and more liable to be hurt if they roll/spin/lose balance). Fleecy vet beds are great for lining things with! However, do make sure that none of these obstacles stand in the bun’s way of reaching food, drink or litter tray – they won’t bother to move if they can’t see a clear path.
Join my Yahoo group On The Wonk for more info and support
If you want to talk to more people about what you’re going through then please do join us at
It’s the group I’ve started to help support owners of headtilt bunnies. We have a growing number of members who can offer advice or just a friendly ear.
- What treatment should my rabbit have?