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Ask a Vet: Why Does My Dog's Head Tilt to the Side?

Dog’s Head Tilt to the Side

If your dog's head tilts to the side, this can be a normal behavior. Dogs tilt their head under a variety of circumstances. But if your dog's head tilt happens out of the blue and appears permanent, you may be worrying about what has happened to your canine companion and what you can do about it.

Can dogs get stroke and can this be the cause of the problem? What can cause my dog's head to tilt to the side? These are all valid questions. It goes without saying that if you woke up to your dog exhibiting a head tilt, you should bring him to your veterinarian so to address the underlying cause. It doesn't hurt though to learn more about what may be going wrong as you wait for you appointment so that you're better prepared and can ask questions. In this article, veterinarian Dr. Ivana Crnec shares what may cause a dog's head to tilt to the side. 

head tilt

Normal Head Tilting Behaviors in Dogs

There are many theories explaining why dogs tilt their heads. Some reasons are completely normal, while others are concerning and require immediate veterinary attention.

For example, dogs with larger noses tend to tilt their heads when interacting with humans. This is because when the head is held normally, the nose blocks the lower portion of the viewing field. Therefore, tilting the head ensures getting a better view. According to a recent study, 71 percent of dogs with large noses tilt their heads during interaction. On the other hand, only 52 percent of the flat-faced dogs share this habit. This suggests that the size of the nose can be a reason for tilting the head to one side.

Dogs also tilt their heads to identify sound sources. Namely, when compared to humans, dogs can hear and recognize a more extensive range of sound frequencies, but sadly they have harder time identifying the source. When a human hears a sound he can tell exactly where it is coming from. However, to achieve the same, dogs need to tilt their heads.

There is even a theory suggesting that dogs prone to tilting their heads during interactions are more intelligent and more closely bonded with their humans. Dogs can recognize certain positive reward words such as treat, walk, food, car ride. When tilting their heads dog are actually trying to listen for those specific words.

Last but not least, head tiling can be a behavior dog parents reinforce without actually knowing it. Simply put, when dogs tilt their head, dog parents laugh and reward their dogs for their funny behavior with treats, ear scratches or simply positive words. Over time, this leads to implementing a trained behavior.

These are all normal behaviors and reasons leading to head tilting in dogs. Sadly, some reasons are not considered normal and can even be classified as medical emergencies.

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Medical Causes of a Dog's Head Tilt to the Side

The most common pathological causes of head tilt in dogs are stroke and vestibular disease. In such cases, the head tilt occurs more frequently and one of the ears is almost always carried closer to the ground than the other.

Stroke Causing Head Tilt in Dogs 

Although common in people, strokes are relatively rare in dogs. A stroke may be caused by a ruptured cerebral blood vessel that leads to bleeding and local brain damage. More commonly, a stroke can be caused by a blood clot that lodges in a brain artery thus depriving the brain from proper oxygen and nutrients supply. When the brain cells are deprived from blood, they become damaged and die.

Stroke is an acute condition that appears suddenly and its symptoms vary greatly. The most frequently reported signs and symptoms include confusion, disorientation, head tilt, seizures, stupor, coma and paralysis. The intensity of the symptoms depends on where in the brain the damage has occurred.

Vestibular Disease Causing a Head Tilt in Dogs 

In dogs, there are two types of vestibular disease – peripheral and central. The peripheral type is much more common.

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The peripheral vestibular disease can be caused by: middle or inner ear issues such as infections, ear mites and perforated ear drum, head trauma, hypothyroidism and side-effects due to certain ototoxic drugs. In addition of the head tilt, dogs with peripheral vestibular disease will show irregular eyeball movements, circling and leaning, inability to focus, loss of coordination, vomiting, nausea and appetite loss.

The central vestibular disease can be caused by: brain issues such as infections, inflammations and tumors, head trauma, hyperadrenocorticism and metronidazole toxicity. Dogs with central vestibular disease usually show signs of body weakness, strange behavior, abnormal eye movements, head tremors, depression and facial paralysis.

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At the Vet's Office 

If your dog develops a head tilt, you may wonder what will happen at the vet's office. When setting the right diagnosis it is important to pay careful attention to the patient’s history and the disease’s progression. The vet will perform a thorough physical examination and then a complete neurological examination. The cranial nerve and postural reaction should be properly evaluated.

The vet is likely to conduct some specific and specialized tests such as head x-rays, MRI, CT scans, urine tests, blood tests, spinal fluid analysis and otoscope examination. If dealing with vestibular disease it is of paramount importance to determine the issue’s localization (central or peripheral).

The exact course of the treatment is determined once the specific diagnosis is made. If the diagnosis is vestibular disease there is no cure other than dealing with causative condition. If the diagnosis is ear infection the treatment includes antibiotics, antifungals and drugs that control the pain and reduce the swelling.

If dealing with a benign tumor the treatment of choice is surgical removal while in case of a malignant tumor chemotherapy and radiation should be considered. If dealing with brain infections, systemic and intravenous antibiotics and antifungals are used. If the cause is metronidazole toxicity, the medication should be stopped and its side-effects are likely to go away within two weeks.

Patients with head tilts usually require supportive care which includes anti-nausea drugs and drugs that reduce the vomiting frequency. Travel sickness drugs are not only very effective, but also available over-the-counter. However, it is not advisable to use them without veterinary directions.

In the past, it was advised to implement restricted activity for patients with head tilts. Today, this advice is changed with protected activity. It has been shown that physical activity, as long as it is in strictly regulated conditions, speeds up the healing process by encouraging faster improvement of the balance problems.

The prognosis of head tilt in dogs depends on the complexity of the underlying cause as well as on the treatment’s promptness and accuracy.

If the diagnosis is vestibular disease, generally speaking, patients with disorders of peripheral origin have a better overall prognosis. On the flip side, the prognosis is usually poor to grave for patients with central vestibular disorders.

About the Author

Dr. Ivana Crnec is a graduate of the University Sv. Kliment Ohridski’s Faculty of Veterinary Medicine in Bitola, Republic of Macedonia.

ivana crnec

She currently practices as a veterinarian in Bitola and is completing her postgraduate studies in the Pathology of Domestic Carnivores at the Faculty of Veterinary Medicine in Zagreb, Croatia.

Ivana’s research has been published in international journals, and she regularly attends international veterinary conferences.

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