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• Home • What is Headshaking? • Symptoms & Checklist • Causes • Diagnose & Therapy • Research • TCM Therapy • Yin & Yang • TCM Practise • Case Reports • Video Clips • Products • Management of the HSer • Content • Contact • Impressum	Cyproheptadine Description and User's Comments Cyproheptadine, brand names: PERIACTIN^®a sedative antihistamine, relieves red, irritated, itchy, watery eyes; sneezing; and runny nose caused by allergies, hay fever, and the common cold. It also may relieve the itching of insect bites, bee stings, poison ivy, and poison oak. Cyproheptadine also is used to stimulate appetite and weight gain. Antihistamines can be utilized for the treatment of headshaking. Photic headshaking has been treated successfully in some horses using Cyproheptadine. Cyproheptadine is an antihistamine and serotonin antagonist (decreases serotonin production). Potential mechanisms for the effectiveness of Cyproheptadine may be via an effect on the trigeminal nerve mediated facial sensation, increasing the synthesis of melatonin, or via its anti-cholinergic effects. Cyproheptadine has also been used successfully in allergy induced headshaking due to its antihistamine action. Cyproheptadine can cause sedation in some horses. Cyproheptadine has also been used successfully in combination with Carbamazepine Source: Annabel Ensor. BVSc. The drug should be started at the lower dose and slowly increased to the maximum recommended dose over the course of 2 or 3 weeks. If signs of anorexia or depression develop, the dose should be reduced to the previous level. It is important to note that the Cyproheptadine dose is based on metabolic weight rather than on conventional body weight. Cyproheptadine causes fewer side effects and is much less expensive than is pergolide but is not as effective. It works on about two-thirds of horses treated in studies Cyproheptadine acts to decrease binding of serotonin. This leads to a decrease in melanocyte stimulating hormone, which acts with ACTH to increase cortisol secretion. I spoke to Dr. John E. Madigan, who is doing extensive research with headshaking horses at UC Davis. He said that serotonin plays a factor in headshaking by over stimulating the trigeminal ganglia/nerve. He explained that the reason why cyproheptadine works with some horses is not because of the antihistamine properties but that it inhibits serotonin from binding and over stimulating the nerve. In his research, they are thinking that horses with headshaking have out of balance levels of LH (lutenizing hormone) and FSH (follicle stimulating hormone), which also regulate serotonin production. I don't know if this makes any sense to anyone, but thought it could make for some discussion? The vet also mentioned that most headshakers are geldings who begin headshaking the first spring after being gelded (thus the LH and FSH implications). He hopes that in the future there could be a hormone shot which would help balance headshaker's systems." Pergolide mesylate (A.K.A. Permax) is another dopamine mimic that is much easier on the animal than Parlodel. It's a little more expensive than cyproheptadine and apparently is often a second choice if cyproheptadine doesn't "take" with a certain horse. Pergolide binds with dopamine receptors in the pituitary to reduce secretion of ACTH leading to a lower blood cortisol level. Any patient may receive smaller or larger doses depending upon individual response to treatment. Owner survey of headshaking in horses. Madigan JE, Bell SA., J Am Vet Med Assoc. 2001 Aug 1;219(3):334-7. Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis 95616, USA. OBJECTIVE: To determine signalment, history, clinical signs, duration, seasonality, and response to various treatments reported by owners for headshaking in horses. DESIGN: Owner survey. ANIMALS: 109 horses with headshaking. PROCEDURE: Owners of affected horses completed a survey questionnaire. RESULTS: 78 affected horses were geldings, 29 were mares, and 2 were stallions. Mean age of onset was 9 years. Headshaking in 64 horses had a seasonal component, and for most horses, headshaking began in spring and ceased in late summer or fall. The most common clinical signs were shaking the head in a vertical plane, acting like an insect was flying up the nostril, snorting excessively, rubbing the muzzle on objects, having an anxious expression while headshaking, worsening of clinical signs with exposure to sunlight, and improvement of clinical signs at night. Treatment with antihistamines, nonsteroidal anti-inflammatory drugs, corticosteroids, antimicrobials, fly control, chiropractic, and acupuncture had limited success. Sixty-one horses had been treated with cyproheptadine; 43 had moderate to substantial improvement. CONCLUSIONS AND CLINICAL RELEVANCE: Headshaking may have many causes. A large subset of horses have similar clinical signs including shaking the head in a vertical plane, acting as if an insect were flying up the nostrils, and rubbing the muzzle on objects. Seasonality and worsening of clinical signs with exposure to light are also common features of this syndrome. Geldings and Thoroughbreds appear to be overrepresented. Cyproheptadine treatment was beneficial in more than two thirds of treated horses. PMID: 11497047 [PubMed - indexed for MEDLINE] Link to data sheet: http://www.medsafe.govt.nz/profs/datasheet/p/periactintab.htm Also it is no cure, it is an anti-allergy med, which suppresses the symptoms! The horse will re-start to headshake the soon the drug is stopped. Some horse owners, which horses proved to be allergic, had results for period given, others not!
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