Boxer Head Bobbing Or Tremors: Causes And What To Do

Head bobbing in Boxers is not well understood but the condition is thought to be benign, insofar as it causes no distress, pain or damage to the dog.

Also known as idiopathic head tremors, head bobbing affects otherwise healthy Boxers, and usually lasts for a few minutes, during which the head shakes uncontrollably but the dog remains fully conscious and aware.

The good news is that idiopathic head tremors are not seizures.

There is no treatment and it’s not unusual for the dog to grow out of them over time.

What Are Idiopathic Head Tremors In Boxers?

Head tremors are a repetitive, involuntary bobbing or shaking of the head.

In medical terms, they are referred to as “focal” head tremors, meaning they are confined to one specific location, the head, rather than being body-wide.

This phenomenon is also called idiopathic head tremor syndrome (IHTS) or episodic head tremor syndrome.

What Do Idiopathic Head Tremors Look Like In A Boxer?

The shaking is quite rapid and can either be in an up-down direction, like nodding “yes” or in a side to side direction, like shaking the head “no”.

The side to side motion is the most common presentation seen in Boxers.

Occasionally there is some circular movement as well.

How Long Does Head Bobbing Last In Boxers?

Idiopathic head tremors are typically brief, lasting just a few minutes.

A minority of dogs experience longer episodes, up to an hour’s duration.

There are even a few reports of head tremors going on for more than 12 hours straight.

Most dogs with IHTS experience quite frequent episodes, ranging from several times a week to many times a day.

They can be as seldom as three to four times a year or less.

The frequency and severity of the head bobbing can vary within the one dog over time.

Are Head Tremors In Boxers Dangerous? Do They Hurt?

Head tremors tend to worry the owner much more than the dog.

For the dog, there is no evidence of pain or distress.

Some Boxers don’t even seem to be aware of the tremoring.

What Is The Prognosis For Boxers With Idiopathic Head Tremors?

There are no known consequences associated with head bobbing, either short or long term.

Most owners observe no ill effects after a bout of head tremors.

Boxers suffering idiopathic head tremors appear to be in good health overall, and are not thought to be any more likely to develop neurological deficits down the track or to experience other health problems connected to the IHTS.

Two thirds of dogs experience spontaneous improvement with episodes decreasing in severity and frequency or resolving completely, over time.

However, head bobbing is clearly not normal in a 100% healthy Boxer — and much of what we “know” about the condition is veterinary conjecture based on best guesses rather than firm fact.

As such, you may wish to optimize your Boxer’s care to eliminate known causes of tremors more generally — more on this when treatment is discussed later.

Signs Your Boxer May Be Having Idiopathic Head Tremors

Your Boxer may have idiopathic head tremors if:

  • The head shakes or bobs uncontrollably, a rapid movement that comes on suddenly
  • Your Boxer remains alert, responsive and mobile during the episode, even able to interact and follow commands (The lack of any disturbance to consciousness is a classic defining feature of idiopathic head tremors)
  • There are no signs of pain or distress, though a small number of dogs are said to display signs of agitation or lethargy
  • You can temporarily stop the tremors by distracting your dog with a treat or by calling his name
  • Other bodily functions remain normal, with no loss of control e.g. no drooling or loss of bladder or bowel control
  • Episodes happen when the dog is awake, dozing or resting
  • Your dog is young to middle aged (88 per cent of affected dogs have their first episode before the age of four, although onset can range from three months to 12 years)

What Causes Head Tremors In Boxers?

Tremors in general can be caused by many different things including:

  • Toxins (Pyrethrins, Metronidazole toxicity, mycotoxins produced by molds)
  • Movement disorders (e.g. paroxysmal dyskinesia, essential tremor syndrome, cervical dystonia)
  • Underlying cerebellar disease (intention tremors)

Note that metronidazole (also called Flagyl) is a very commonly prescribed but strong antibiotic, readily dispensed by vets as an antidiarrheal — usually without conveying to the owner that it can have neurological side effects.

This drug is also known to have immune-modulating activity and is sometimes used to treat inflammatory bowel disease, as well as the protozoal infection giardia.

According to the veterinary literature, tremors caused by toxins and movement disorders differ from idiopathic head tremors in that the head is not usually affected, particularly not in isolation and these kinds of tremors are not episodic.

With intention tremors, the head tremor is triggered by action or goal-oriented movement and does not occur at rest or in a neutral head position as it does with idiopathic head tremors.

Why Do Idiopathic Head Tremors Happen?

Idiopathic head tremors arise from involuntary contractions of the muscles in the head and neck.

But what triggers the contractions?

Vets don’t know, which is what the word “idiopathic means”: spontaneously arising, of unknown cause.

There is likely to be an underlying genetic basis, given that certain breeds are more affected than others.

Several theories exist as to the cause of idiopathic head tremors.

Perhaps the leading contender is that head tremors result from an abnormality involving the trigeminal nerve in the jaw, which in turn affects the stretch reflex mechanism in the neck.

However, unexplained head tremors in Boxers have anecdotally been associated with:

  • Certain foods
  • Particular supplements
  • Flea/tick treatments
  • Heartworm medication
  • Heat cycles in females
  • Moving between different temperatures (e.g. hot exterior into air conditioned house)

Flea And Tick Treatments, Intestinal Wormers, Heartwormers And Head Tremors

The Food and Drug Administration has warned that drugs of the isoxazoline class can cause “adverse neurological events” in some dogs, including:

  • Muscle tremors
  • Ataxia
  • Seizures in dogs with no prior history

While issuing the warning, the FDA did not require the products to be removed from sale.

They include:

  • Bravecto (fluralaner) tablets for dogs
  • Bravecto (fluralaner) topical solution for cats and dogs
  • Bravecto 1-month (fluralaner) tablets for dogs
  • Credelio (lotilaner) tablets for dogs and cats
  • Nexgard (afoxolaner) tablets for dogs
  • Simparica (sarolaner) tablets for dogs
  • Simparica Trio (sarolaner, moxidectin and pyrantel) tablets for dogs

Consider safe alternatives to these chemicals.

Many pet dogs have no issue with parasites in the first place, making these products all risk, no benefit.

For gastrointestinal worms, best practice is no longer to use a monthly chemical wormer, certainly not without first returning a positive fecal test and knowing which specific worm is causing a problem.

The latest science indicates a small worm burden is actually protective against immune and inflammatory disorders.

There are natural ways to protect your Boxer from fleas.

Heartworm is spread by the bite of an infected mosquito and so is not necessary year-round or when your dog has no exposure to mosquitos.

The best defence against parasites of all kinds is to feed a raw meaty bone-based diet.

A decade-long study known as “Pottenger’s cats” showed that gastrointestinal parasitism was largely a problem of cats fed cooked food rather than their natural raw diet of bones, muscle meat and offal.

The findings apply equally to dogs, and to any animal and its biologically-appropriate diet.

Are Boxers Predisposed To Head Tremors?

Any dog can experience idiopathic head tremors.

But, Boxer dogs are among the predisposed breeds.

According to a study of 291 dogs published in the journal Veterinary Medicine International in 2015, the breeds most often affected include:

  • Bulldogs (37% of affected dogs)
  • Boxers (13%)
  • Labrador Retrievers (11%)
  • Dobermans (8%)
  • Staffordshire Terriers (3%)

Most of the dogs with IHTS were purebreds (84%).

However, that means a substantial number of mixed breed dogs are also affected (16% of all dogs with idiopathic head tremors according to the 2015 study).

What Not To Do When Your Boxer Has A Head Tremor

1. Don’t Panic If Your Boxer’s Head Starts Shaking

It’s best not to overreact or make a big deal of it — this causes more stress to your dog than the tremors themselves.

2. Do Not Assume Head Tremors Are Seizures

When a Boxer’s head shakes, it is sometimes mistaken for an epileptic seizure.

Idiopathic head tremors are not focal seizures.

A dog with idiopathic head tremors will show no other neurological abnormalities.

Because the usual treatment for seizures is a drug called phenobarbital, it’s critically important to get a proper, skilled diagnosis.

Otherwise you may end up with idiopathic head tremors misdiagnosed as seizures and your dog pointlessly medicated with an anti-epileptic drug that has no effect on idiopathic head tremors and, worse, is known to damage the liver with prolonged use.

3. Do Not Medicate Your Boxer For Idiopathic Head Tremors

Treatments that have been tried and found to make no significant difference to head tremors include:

  • Anti-seizure meds including phenobarbital, potassium/sodium bromide, diazepam
  • Corticosteroids
  • Supplements like fish oil
  • Clonazepam
  • Calcium carbonate

How To Diagnose Idiopathic Head Tremors In Boxers

The first thing to do is video your Boxer during an episode so you can show your veterinarian what it looks like.

Keep a note of when tremors happen, what preceded it, how long they last and any other details you can.

This information may help identify patterns or your Boxer’s potential triggers.

No specific test can conclusively tell you your Boxer has idiopathic head tremors.

A formal diagnosis is made by ruling out other possible causes of head shaking such as a progressive central nervous system disorder, or an ocular (eye) problem.

Tests your vet may suggest include:

  • Full neurologic exam
  • Eye exam
  • Cervical (neck) and brain MRI
  • Spinal tap to allow analysis of cerebrospinal fluid (CSF)
  • Bile acid test
  • Full lab tests including blood (both hematology and biochemistry) urine, liver function and thyroid hormone)
  • Neurometabolic screening of blood and urine
  • PCR testing for canine distemper virus

Before embarking on extensive testing, including scans and invasive procedures like a spinal tap, it’s worth seeing if the episodes can be consistently stopped by using distraction.

If so, this is usually enough to settle on a diagnosis without further expense and stress to the dog.

How To Treat Idiopathic Head Tremors In Boxer Dogs

The prevailing veterinary view is that idiopathic head tremors are harmless and require no treatment — which is lucky because none exists.

However, this doesn’t mean there is nothing you can do.

What To Do During An Episode

During an episode, the vast majority (87% according to the 2015 study) of dogs can be snapped out of head bobbing using distraction.

You will probably be able to stop your Boxer’s head tremors, at least temporarily, by:

  • Saying your Boxer’s name
  • Offering a treat or toy
  • Otherwise attracting his attention

Why does this work?

The fact that tremors can be interrupted by using distraction is consistent with the theory that head tremors are caused by an abnormality of the trigeminal nerve.

When the dog reaches to take a treat, the neck muscles contract, releasing the stretch mechanism that had malfunctioned, caused the tremor.

Note, some owners are under the impression that the treat needs to be honey, or a specific, sweet food.

They believe it’s the sugar hit to the bloodstream that stops the tremor.

This is not the case, as evidenced by the fact that any form of distraction — including non-food distractions — will have the same effect.

It’s the distraction, and the movement to reach for the treat, that makes the difference.

Note, ice cream, sometimes suggested for head tremors, is not appropriate food for your Boxer.

Karo syrup, also often suggested, can have a laxative effect and is, likewise, not recommended.

Here are some ideas for healthy treats for your Boxer.

Note that a simple distraction doesn’t always work and sometimes head bobbing continues even during interaction with the owner.

If a tasty treat doesn’t snap your Boxer out of it, and the tremor doesn’t stop on its own after five or ten minutes, you can try a bigger distraction, like going for a gentle walk outside to reset your dog’s system.

Some owners find physical contact with the head, like having the Boxer lie down. or supporting the head with a pillow, stops the shaking.

What To Do To Help Prevent Further Head Tremors

While there is no “treatment”, as such, for idiopathic head tremors, the association of tremors with toxicity of various kinds provides you several avenues.

Even without identifying your Boxer’s trigger, it’s recommended to:

  • Optimize the diet by avoiding processed dog food like kibble, and instead feeding your Boxer a fresh, natural raw canine diet consisting of muscle meat, raw meaty bones and a little offal, home prepared
  • Eliminate toxic exposures to chemicals in dewormer meds, flea/tick treatments, heartwromers and the like
  • Avoid tap water because of its contaminants
  • Stop or minimize the use of chemicals in the home and garden including weedkiller, cleaning sprays and scented plugins, which are known to cause hives and other toxic reactions in Boxers

Some owners reportedly find increasing vitamin B intake reduces the frequency of head tremoring episodes.

If you feed a properly composed raw diet, your Boxer will receive all the vitamin B he needs for optimal health through consumption of vitamin B rich whole foods including chicken, red meat and offal like liver and kidney.

Other indications of toxic accumulation in Boxers that are often overlooked include:

Other Causes Of Head Shaking In Boxers

Other causes aside from seizures and idiopathic head tremors can be responsible for a Boxer starting to shake his head.

Things can cause head shaking or other strange repetitive movements of the head and neck include:

  • Wax build up
  • Itchy or irritated ear/Yeast overgrowth in the ear (gunky ears often perceived as an ear “infection”)
  • Acid reflux (Other symptoms may include jaw snapping, neck stretching, hard swallowing)
  • Play, attention seeking or waking up behavior (similar to shaking his coat off when he stands up)
  • Foreign body in the ear e.g. dirt and debris, grass seeds

If these issues are at play, your Boxer may have accompanying symptoms such as:

  • Odor from the ear
  • Holding head at odd angle
  • Sensitivity to touching the ear

Conclusion

Idiopathic head tremors, by definition, are tremors that cannot be explained by current veterinary science, nor tied to a clear cause.

The classic, defining features of IHTS, and the most useful in reaching a diagnosis, are that the dog remains otherwise alert and normal during an episode, displays no other neurological symptoms and stops head bobbing when distracted.

If your Boxer is experiencing head tremors, it’s a good time to clean up the diet and other inputs to make sure toxins are not building up in his system and causing abnormalities.

References

ASPCA Pro, Most Common Toxicologic Causes of Tremors in Dogs

FDA, Fact Sheet for Pet Owners and Veterinarians about Potential Adverse Events Associated with Isoxazoline Flea and Tick Products, current as at 08/13/2021

Landstra, Laura and McDonnell, Jay, Six Questions About Idiopathic Head Tremors, Veterinary Neurology and Imaging of the Chesapeake

Lowrie M and Garosi L, Classification of involuntary movements in dogs: tremors and twitches, Vet J, 2016

Michaels, Jennifer, Idiopathic Head Tremor Syndrome, MSPCA Angell

Pottenger, Francis M Jr, MD, Pottenger’s Cats: A Study in Nutrition, Price-Pottenger Nutrition Foundation, 1983

Shell LG et al, Clinical and breed characteristics of idiopathic head tremor syndrome in 291 dogs: a retrospective study, Veterinary Medicine International, 2015