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A Vet Answers Your Most Pressing Questions About Head Pressing

Recently, there was an article sweeping the internet about “head pressing.” Although rare, it is something to watch for, especially if your dog suffers from one of the conditions that can cause head pressing.

We spoke with Dr. Kim Smyth, staff veterinarian and pet health writer at Petplan Pet Insurance to get some more in-depth answers to our questions.

What Exactly is “Head-Pressing”?

The term “head pressing” is actually pretty descriptive—the affected pet stands close to a wall or other hard surface (furniture, the corner, etc) and literally presses the top of her head against it. It almost always signifies significant illness.

What are the illness/diseases that can cause this behavior?

Many diseases can have head pressing as a clinical sign, but most often we associate it with hepatic encephalopathy, a condition that occurs in pets with liver disease. The liver is meant to remove toxins from the blood stream. When it doesn’t function properly, ammonia and other toxins build up and create this neurologic syndrome of head pressing.

Many breeds are predisposed to liver shunts, a condition in which blood bypasses the liver. Head pressing is a common clinical sign in these pups because of the hepatic encephalopathy that occurs secondary to the liver shunt.

Other conditions that can cause head pressing are:

  • Hydrocephalus (water on the brain)
  • Tumors in the brain
  • Strokes or vascular accidents in the brain
  • Head trauma.
  • Inflammatory and infectious types of meningitis and encephalitis
  • Any kind of trauma to the head or brain can potentially cause head pressing.

Are these disease and illness hereditary?

Some diseases, like liver shunts and hydrocephalus ARE hereditary. Pets with these conditions should not be bred. The other causes mentioned are not hereditary.

Any other symptoms people should look for?

Depending on the underlying cause for head pressing, other symptoms will likely be apparent. In the case of the most common presentation (hepatic encephalopathy), owners will likely see signs of liver disease including:

  • Jaundice (yellowing of the whites of the eyes and gums)
  • Weight loss
  • Increased urination
  • Increased water intake
  • Lethargy
  • Mental dullness (particularly after a meal)

Are there any Preventions?

Not specifically. Many of the conditions that lead to head pressing are just luck of the draw. By keeping your pet healthy, up to date on vaccines, and on appropriate external and internal parasite control, you can avoid some of the infectious causes of encephalitis, however.

What is the prognosis of an animal that displays this behavior? Does waiting to seek treatment make a difference?

Prognosis largely depends on the underlying cause. There are treatments for many of the conditions that lead to head pressing, and often pets can make a full recovery.

For most veterinary illnesses, the sooner treatment is sought, the better. When pets come to us already weak and dehydrated from several days or weeks of illness, we are behind the 8 ball before we even begin.

How quickly could this turn deadly?

Again, this is highly variable depending on the underlying cause. If you see your pet displaying head pressing, he or she should be seen by a veterinarian the same day.

While this dog doesn’t exactly look happy, he is not “head pressing.” Don’t get confused and think if your dog is rubbing on you for affection, or lying against a wall, that he his head pressing. You will have a lot of unnecessary vet bills if you do.

Any other information readers need to know?

You should not be concerned if your pet rubs his or her head against you for affection or attention. This kind of head butting is completely different from head pressing, which is an obvious effort to press the head into firm stationary objects.

How to Treat Seizures in Dogs and Cats

What to do if your pet is having a seizure
Seizures stress your pet and your family, but being able to take effective action helps your pet and your family. These are some guidelines:

  • Remain calm and speak to your pet in a soft, comforting voice.
  • Put light pressure on your pet’s eyeballs for a minute if it is safe for you to do so.
  • Prevent injury and protect your pet from damaging his or her head by moving objects away from your pet. Do not try to move your pet during a seizure because you may be bitten.
  • Do not approach your pet’s head or the mouth because you may be bitten.
  • Do not put medication in your pet’s mouth while he or she is having a seizure or unable to swallow.
  • Clean up urine or feces without punishing your pet.
  • Document the event and what led up to the event in a seizure diary.
  • Get emergency help if seizures last more than five minutes or if a second seizure occurs before the brain has completely recovered.
  • Give medications as prescribed by your veterinarian, such as rectal Diazepam.

Place pressure on your pet’s eyeballs
Pushing on the eyelids enough to depress the eyeball slightly for 10-60 seconds stimulates the vagus nerve. The vagus increases signals from the calming (parasympathetic) segment of the nervous system and this slows down rapid nerve cell activity characteristic of seizures. If your pet is having a seizure, eyeball pressure helps decrease seizure duration.
Applying eyeball pressure for a minute or two every day before your pet falls to sleep, may help decrease the frequency and severity of seizures. Eyeball pressure also lowers blood pressure.

Treatment options for pets with seizures
Seizures in dogs and cats that occur more often than once a month, occur with ferocity, last for more than 90 seconds, or result in aggressive behavior require treatment.

Treatment for your pet’s seizures should include steps that:

  • Strengthen the brain
  • Strengthen the liver
  • Avoid toxins
  • Provide a stable environment
  • Give medication to prevent uncontrolled brain activity
  • Provide surgical relief to brachycephalic dogs
  • Include alternative therapies

When the tendency to develop seizures is inherited, it is best to neuter or spay affected pets.

Strengthen your pet’s brain
Supplements that strengthen your pet’s brain and build healthy nerve cells and neurotransmitters decrease the likelihood of seizures:

    helps make the brain neurotransmitter acetylcholine.
  • SAMe in Denosyl provides antioxidants that benefit the brain (and liver). contains Omega 3 fatty acids that help normalize brain cell membranes. and Be Well for Cats contains Omega 3 fatty acids that help normalize brain cell membranes.

Strengthen your pet’s liver
The liver is responsible for removing toxins from the blood. It also controls blood glucose and the amount and type of blood proteins. When your pet’s liver is weak and functions poorly, materials enter the bloodstream that can penetrate the blood brain barrier and trigger seizures. To strengthen your pet’s liver and keep the blood that circulates through the brain healthy, do the following:

  • Feed no chemicals, fillers, or dyes which the liver will have to process.
  • Provide natural, wholesome pet food.
  • Provide filtered water.
  • Supplement with milk thistle (silymarin or silybum) such as Super VitaChews Soft Chews.
  • Supplement with SAMe, found in Denosyl, to provide antioxidants and liver purifying glutathione.
  • Use homeopathic medications such as Hepar from HeelUSA.

Keep your pet away from toxins
Exposure to poisons or toxins stresses your pet’s liver, predisposing him or her to seizures. The following are potential toxin exposures:

  • garages,
  • workshops,
  • bathrooms,
  • new carpets,
  • recently painted walls,
  • recently treated decks,
  • lawns recently treated with fertilizers, herbicides, or pesticides.

Provide a stable environment for your pet
Most pets with seizures have difficulty adjusting to even small changes in their environment, exercise level, food, or medication. Among the events that can increase the tendency for these pets to have seizures are:

  • changes in the family structure, such as the addition of a baby or another pet,
  • traveling,
  • loud music,
  • loud holiday company,
  • missed meals,
  • late bedtime or changes in sleep cycle,
  • sudden changes in any medication, and
  • changes in the amount of exercise.

Give your pet medication to prevent seizures
The two most commonly used prescription anti-seizure medications for pets are phenobarbital (PB) and potassium bromide (KBr or K-BroVet Potassium Bromide). Diazepam is not used to prevent seizures in dogs because the effects last about 20 minutes. Cats with epilepsy can be given Diazepam as well as PB and KBr because the effects last 20 hours in cats. Primidone, which is metabolized to phenobarbital in the body, is prescribed for dogs, but many veterinarians do not recommend it for cats.
For pets with primary or idiopathic seizures, anticonvulsant medication addresses the problem. For pets with secondary seizures, a group that includes most cats, anticonvulsant medication may resolve the symptoms but it doesn’t address the cause.
Most pets that start on anti-seizure medications must take them for life.

Effectiveness of BP and KBr
Even when diets, dosages, and all else remains ideal, between 20-30% of dogs are not helped by either PB or KBr.

Side effects of BP, KBr, and Primidone
Unfortunately, PB, KBr, and Primidone and may have serious side effects in your pet: liver damage, drowsiness, weight gain, change in personality, and interfering with bone marrow so that your pet has insufficient infection-fighting white blood cells and blood clotting cells (thrombocytes).

Decreasing the side effects
To decrease the possibility of side effects—which are more severe as the dosage is increased—some veterinarians recommend using smaller amounts of two medications rather than a large amount of one medication. Veterinarians also recommend avoiding toxins and using supplements to support the brain and liver so that medication dosages can be kept to a minimum.

PB, KBr, and Primidone: Slow to act
If your pet is diagnosed with seizures and prescribed these medications, be aware that PB and KBr are slow to become effective. Phenobarbital takes two weeks to reach a steady state and KBr takes three to four months. Periodic blood tests are necessary to measure your pet’s blood levels.

KBr and salt intake
For pets on KBr, it’s important not to change the amount of salt in the diet. Because KBr is a salt, it competes with normal table salt to remain in the body. If your pet’s salt intake suddenly increases because you switch to a different pet food or give salty treats such as hot dogs, luncheon meats, or ham, the kidneys recognize there is sudden increase in salt. To control the salt level, the kidneys eliminate KBr along with sodium chloride. This elimination lowers the therapeutic blood levels of KBr and can lead to seizures.

BP and primidone affect hormones and other medications
Phenobarbital (PB) and Primidone can lower thyroid hormones (T4) and increase thyroid stimulating hormone (TSH), creating hypothyroidism in dogs. In addition to affecting hormones, PB can affect and be affected by other medications. For example, PB decreases the effect of these medications: oral anticoagulants such as warfarin, steroids such as Prednisone, antibiotics Doxycycline and Metronidazole, and the asthma drug Theophylline.

Anti-seizure medications that don’t work in pets
Do not be tempted to try Phenytoin, valproic acid, and Carbamazepine. These are effective human anti-seizure medications but they do not work the same in pets as they do in people.

Medications that should never be given to pets with epilepsy
Some medications increase the possibility that pets will have seizures. These prescription medications should not ever be given: Acepromazine, Ketamine, and Xylazine (Rompun).

Which pets should take anti-seizure medication?
Anti-seizure medication is recommended for pets that have more than one seizure every four to six weeks, have cluster seizures, have extremely violent seizures, are less than a year old when seizures begin, have structural problems within the brain causing the seizure (hydrocephalus, cancer), or are aggressive during recovery.

Provide surgical relief to brachycephalic dogs
Surgery helps brachycephalic dogs with short, flat noses so that more oxygen reaches their brains. The surgery shortens the soft palate so that the throat doesn’t collapse and widens the tiny nostrils so that more air enters the nose. Among the breeds that may benefit are English Bulldogs, Pugs, Pekingese, Shih Tzus, and Boston Terriers.

Consider alternative therapies for your pet
Holistic veterinarians recommend the following to decrease the severity and frequency of seizures:

Do not attempt to put medication in your pet’s mouth during a seizure
It is dangerous for you and your pet to place anything in your pet’s mouth during the seizure. Pets having a seizure don’t swallow normally and medication put in their mouths can run down into the lungs. It is also dangerous for you, the pet guardian, because your pet may bite during a seizure. Diazepam (Rx) can be given rectally to a seizing pet. Homeopathic medications, such as Aconitum, Cocculus, and Nux Vomica, can be given rectally.
If your pet has gold beads implanted at acupuncture points, they can be massaged during a seizure.
Pets are a lot like people, so keep them healthy as best as you can by following the same advice as you would for a human having a seizure.