The terms head tilt, torticollis and wry neck in rabbits are used to describe the twisting or tilting of the neck characterized by head tilt, often on either side (left or right). It is often accompanied by “nystagmus, a constant, involuntary movement of the eyeballs”  among other symptoms, depending on the cause.
This condition is not a disease on its own but a sign that there is a problem with the various balancing components that include the vestibular system, central nervous system, visual system, among others.
The vestibular system aids in ensuring proper spatial orientation of various body parts, balance, and coordinated movement of limbs and body trunk. It is made up of the vestibular nerve, medulla of the brain and labyrinth (semicircular canals, cochlea, and vestibule).
Therefore, understanding the ear anatomy especially how balancing and correct body parts orientation is achieved is very important in knowing and dealing with the various causes of head tilt in bunnies.
A wry neck or torticollis in rabbits
A wry neck or torticollis in rabbits is a condition that tightens or contracts the neck muscles on one side making the neck to be tilted or twisted and hence a head tilt or rotation. This dystonic condition causes not only an abnormal but also an asymmetrical head and neck position.
Head tilt in rabbits symptoms
A number of symptoms can be used to identify this condition. These symptoms may vary since different causes may be accompanied by other symptoms and they can appear gradually or all over a sudden. The commonly noted ones include:
- Head tilting or twisting downwards to one side away from the normal body and limb orientation.
- Ataxia – lack of muscle coordination, rolling, circling and uncoordinated movement
- Nystagmus – eyes moving from side to side quickly or swinging involuntarily that can be vertical, horizontal or rotatory.
- Head shaking
- Ear scratching
- Horner’s syndrome “characterized by the drooping eyelid, sunken eye, and relaxed third eyelid.” 
- Not eating and nausea.
There are other symptoms that may be specific to the cause of head tilting in rabbits such as anorexia, hind leg paralysis, and weakness, inability to walk, among others. In some cases, your pet will continue eating and drinking as usual.
Finally, it is normal for bunnies to fall on one side while doing bunny flops. This has nothing to do with a head tilt. Your bunny is only excited or happy.
What causes a head tilt in rabbits
There are many possible causes. Some of the common ones include the following:
Vestibular diseases and conditions
Any disease or condition that affects the vestibular system including brain abscesses, inner ear infections, bone tumors, toxins, trauma, E. cuniculi. idiopathic vestibular syndrome and degenerative diseases may result cause a head tilting and wry neck. We are going to look at some of these causes individually.
Some common symptoms that may accompany vestibular diseases include a false sense of movement (spatial orientation, motion, and balance), vertigo, hearing loss, nasal and ear discharges, tremors, and so on. These symptoms will depend on the underlying causes.
Once diagnosis reveals the cause of vestibular diseases, treatments may include antibiotics (bacterial infections), correctional surgeries, NSAIDs, antiparasitic medications, and so on. Check for details on vestibular disease including treatment and symptoms.
E. cuniculi and encephalitozoonosis
The E. cuniculi is a protozoan parasitic infestation that causes encephalitozoonosis and it may affect the spinal cord, brain, liver, lungs, kidney among other organs causing inflammation.
Some of the possible symptoms may include “head tilt, loss of balance, rear leg weakness, or paralysis to being without symptoms”  Also, seizures, blindness, loss of appetite, neck spasms, ataxia, circling, rolling and other neurological symptoms may be noted.
Once diagnosed, treatment is by fenbendazole medications such as Panacur® or Lapizole® as well as benzimidazoles such as oxibendazole and albendazole. To effectively manage, you should read more on E. Cuniculi, to know more about other symptoms, transmission, treatment, and recovery.
Ear Infection and heat tilt
Rabbits can suffer from outer, middle or inner ear infections. If outer ear infections spread to the middle and inner parts or there are infections on the middle and inner parts of your rabbit’s ears, this animal may end up with ataxia (rolling, circling and lack of full-body control), head tilt, facial paralysis, nystagmus, among other symptoms.
Usually, the head tilting and other neurological symptoms arise when the infection affects the labyrinth, which is part of the vestibular system by bacterial infections such as Pasteurella multocida, Streptococcus spp., Pseudomonas spp., Enterococcus spp, Proteus spp. Escherichia coli as well as some yeast and fungal infections.
Treatments include the use of antibiotics, surgery, NSAIDs, antifungals as well as electrolyte and fluid therapy to stabilize some of the neurological symptoms, and so on. We have more on ear infection including causes, treatments, diagnosis, and recovery.
Ear mite infestation
Untreated rabbit ear mite (Psoroptes cuniculi) may lead to secondary bacterial, yeast or fungal infections that can spread into the middle and inner ear. Should they affect the vestibular system, a head tilt may be one of the possible symptoms.
However, these non-borrowing mites do not directly cause this condition but will cause symptoms such as ear and head shaking, scratching as well as ear drooping, crusting especially on the inner part of the pinna and ear canal.
Treatments are by the use of ivermectin or selamectin such as Revolution, and some home remedies. Knowing how ear mites are transmitted, their symptoms, treatment, and control will be essential in managing these ectoparasites.
Cerebral larva migrans
Sometimes, the Baylisascaris spp. (a type of roundworm in raccoons and skunks) eggs can be transmitted to rabbits through feces-contaminated food, water, bedding, etc. Note that rabbits are this roundworms intermediary host.
If a rabbit ingests these eggs, they hatch and their larval stage may move to the brain where it can destroy brain tissues and potentially cause a head tilt. Since medications such as ivermectin may not penetrate the brain in needed amounts to kill the larvae, cure presents a lot of challenges.
Strokes may cause a number of symptoms including loss of control of one side of the body. This may cause symptoms including “a droopy face, drooling, and eyes that do not function correctly”  and sometimes make this animal to move or not move in circles.
Affected bunnies require assisted living if they are unable to eat, move or drink as usual and it may take long before their normal function improves or returns to normal.
Neck and head trauma may cause brain damage or affect any organs that are essential in maintaining the correct spatial orientation of body parts, body balance or coordination. Also, panicking after trauma can be another cause.
NSAIDs may be recommended depending on what caused the trauma as well as other treatments that your vet may recommend.
Growths or tumors both cancerous and non-malignant that may affect the ear, neck, brain, which may lead to their head being tilted.
Ingesting various toxic materials such as lead, zinc, or toxic plants like woolly pod milkweed can lead to this condition. Chelation may be the recommended treatment option.
Contraction of the muscles can be another reason for a temporary head tilt which will resolve on its own once the muscle relaxes.
Also, intracranial abscesses associated with dental diseases and metabolic diseases that cause accumulation of toxins on various organs especially in the brain, heatstroke, among others may cause staggering, loss of balance, circling, among other signs.
If you notice any of the wry neck or head tilt symptoms, you need to see your vet for diagnosis. Early diagnosis may help cure some causes.
Diagnosis will involve skull radiography, CT scans, MRI, biopsies, bloodwork including total blood count, urinalysis, culture and sensitivity tests, and so on depending on what is suspected to be the cause.
Also, serology including the IgM, IgG as well as C-reactive protein among other tests may be performed by your vet.
Head tilt in rabbits treatment
Early detection and treatment are very important for a good prognosis. This will depend on the cause as some causes might be easy to treat if detected early while others may not be treatable.
Treatments may involve antibiotics, antiparasitic medications, NSAIDs and so on depending on the cause as well as good supportive care during recovery. Acute cases may require hospitalization, and intense veterinary and nursing care.
During the tilting of the head, the eye facing down might require an ophthalmic ointment to stop it from drying (keep it moist)
Head tilt in rabbits recovery
During treatment for treatable cases, supportive care is very important as well as providing a quiet, clean environment. Note that some cases may be managed while others will need may need assisted living.
If your furry friend has this problem, you need not to be worried as “head tilt is usually not only survivable but treatable, though recovery may be gradual”  and it needs you to be patient.
Once treatment has begun, this pet may benefit from physiotherapy and regular exercise. A large area with good grip may be recommended in case of circling and rolling to reduce injuries.
Also, line cages with bedding (such as synthetic sheepskin mats, towels, blankets, etc.) to avoid injuries in case your rabbit loses control. Do not forget to remove any obstacles in their hutches and ensure their bedding is always kept dry and have a good grip. Wrapping affected bunnies in a bunny burrito may help reassure them.
Furthermore, avoid picking them if they lack balance and if you must ensure you make them feel secure by holding them firmly.
Additionally, ensure water and food are easily accessible for buns that can eat and drink and ensure they get enough amounts of hay, some leafy greens including cilantro, collard greens, carrot tops, parsley, among others and treats such as fruits or carrots.
In case of vertigo and severe balancing issues, your vet may consider forced syringe feeding with foods such as Critical Care for Herbivores or Emeraid Herbivore. Furthermore, subcutaneous fluids may also be considered if the rabbit is not eating or drinking as it can result in GI stasis and or hepatic lipidosis.
Note that affected rabbits can still live happily and comfortably if the condition does not cause pain and they are able and enjoy eating, drinking and they are loved.
Finally, euthanasia should only be contemplated if these animals cannot eat, drink or behave normally. Having a permanent case of the wry neck should not encourage euthanasia.
Sometimes, death may result due to the various causes we have looked at, i.e., some of the causes of rabbit head tilt may cause death.
Avoid or minimize exposure to ear mite, ear infections and give good rabbit husbandry. Furthermore, handle your bunnies with care to avoid trauma and injuries.
Also, get rid of any toxic materials that may be accidentally ingested by this animal. These might include some plants or containers you use that may not be pet safe.
Finally, provide a balanced diet, keep their food and water clean, ensure you maintain proper hygiene and avoid overcrowding. This will reduce vulnerability to bacteria, parasites, and other organisms.