Head Pressing

The Science Behind It

Head pressing is one of the very few feline behaviours that is never normal. The cat walks up to a wall, a corner, the side of a sofa or a radiator, lowers its head, and pushes the crown of the skull steadily against the surface — sometimes for a few seconds, sometimes for many minutes, often with a blank, unfocused expression. It is a compulsive act driven by damage or dysfunction in the forebrain, and it is a recognised sign of a group of conditions collectively described as forebrain disease.

The most common underlying cause in cats is hepatic encephalopathy, in which a failing liver or an abnormal blood vessel called a portosystemic shunt allows ammonia and other toxins to bypass the liver and reach the brain. Other causes include brain tumours, high blood pressure with associated brain swelling, poisoning, severe infections such as toxoplasmosis or cryptococcosis, and metabolic crises like severe kidney failure. Whatever the trigger, the mechanism is similar: raised pressure and abnormal signalling in the forebrain produce a disoriented animal that seeks the odd, unhelpful relief of pressing its head against something solid.

How to Tell It From Head-Bunting

Owners understandably confuse this with the affectionate head-butt, and the distinction is worth learning properly. Ordinary bunting is a brief, deliberate, social act — your cat swings its head against your hand or leg with a purposeful little shove, often purring, then repeats it or moves on to rub its cheek along you. Head pressing is different in almost every respect:

• It is directed at inanimate objects — walls, corners, furniture legs — rather than at people or other cats
• It is sustained rather than a quick bump, with the cat holding position and leaning
• The cat looks vacant or distressed rather than pleased, and does not purr
• It often comes with other neurological signs — circling, pacing, staring, pupils of unequal size, or apparent blindness
• The cat may seem unaware of you or unresponsive to its name

What It Means for You

It means a same-day veterinary appointment, and an out-of-hours one if it is night. Head pressing is not a behavioural quirk to monitor, and there is no home management for it. The underlying causes are diverse but many of them — hepatic encephalopathy, hypertension, some infections — respond well to treatment when caught early and very poorly when caught late.

Take a phone video if you can do so quickly. Neurological signs are notoriously intermittent, and a cat that pressed its head against the skirting board for five minutes at home may present as apparently normal in the consulting room. A short clip removes all doubt and helps the vet decide how urgently to pursue imaging and bloodwork.

What Happens at the Vet

Expect a neurological examination, blood pressure measurement, and blood tests including liver function and bile acids. Depending on the findings, the next steps may be abdominal ultrasound to look for a shunt, or referral for MRI of the brain. Treatment is directed entirely at the cause: lactulose and dietary protein modification for hepatic encephalopathy, amlodipine for hypertension, antifungals or antibiotics for infection, and surgical or interventional correction for some shunts.