In horses with trigeminal-mediated headshaking, is neuromodulation with EquiPENS™ more effective than with electroacupuncture?



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PICO question

In horses diagnosed with trigeminal-mediated headshaking, is EquiPENS™ therapy more efficacious when compared to electroacupuncture in terms of remission of clinical signs?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Three papers were critically reviewed, all three were descriptive case series

Strength of evidence


Outcomes reported

Remission was achieved following both EquiPENS™ and electroacupuncture therapy in a proportion of horses for variable lengths of time. Median remission times appear to be longer with repeated treatment of EquiPENS™ compared to electroacupuncture


The evidence for EquiPENS™ treatment is more robust than for electroacupuncture, and remission defined more clearly, and so could be recommended with greater confidence


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Aleman, M., Williams, D.C., Brosnan, R.J., Nieto, J.E., Pickles, K.J., Berger, J., LeCouteur, R.A., Holliday, T.A. and Madigan, J.E. (2013). Sensory nerve conduction and somatosensory evoked potentials of the trigeminal nerve in horses with idiopathic headshaking. Journal of Veterinary Internal Medicine. 27(6), 1571–1580. DOI:

Devereux, S. (2019). Electroacupuncture as an additional treatment for headshaking in six horses. Equine Veterinary Education. 31(3), 137–146. DOI:

Dobrota, V.D., Hrabac, P., Skegro, D., Smiljanic, R., Dobrota, S., Prkacin, I., Brkljacic, N., Peros, K., Tomic, M., Lukinovic-Skudar, V. and Kes, V.B. (2014). The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health and Quality of Life Outcomes. 12(1), 171. DOI:

Pickles, K., Madigan, J. and Aleman, M. (2014). Idiopathic headshaking: is it still idiopathic? The Veterinary Journal. 201(1), 21–30. DOI:

Madigan, J.E. and Bell, S.A. (2001). Owner survey of headshaking in horses. Journal of the American Veterinary Medical Association. 219(3), 334–337. DOI:

Mills, D.S., Cook, S. and Jones, B. (2002). Reported response to treatment among 245 cases of equine headshaking. Veterinary Record. 150(10), 311–313. DOI:

Roberts, V. (2019). Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies. Veterinary Medicine: Research and Reports. 10, 1–8. DOI:

Roberts, V.L.H., Bailey, M., Equipens™ group, Patel, N.K., Carslake, H.B., Malalana, F., McGowan, C., Haggett, E.F., Barnett, T., Rendle, D.I. and Lunden, U. (2020). The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking in 168 horses. Equine Veterinary Journal. 52(2), 238–243. DOI:

Roberts, V.L.H., Patel, N.K. and Tremaine, W.H. (2016). Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking: a safe procedure resulting in medium‐term remission in five of seven horses. Equine Veterinary Journal. 48(2), 201–204. DOI:

Vol. 6 No. 1 (2021): The first issue of 2021

Section: Knowledge Summaries

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