A nine-year-old Warmblood gelding was presented with a clinical history of irritable behavior when being ridden, tic-like movements of the head, and laryngeal hemiplegia. It was noted that clinical signs were exacerbated by intense exercise and sun exposure. Due to the clinical signs observed and exclusion of other etiologies, a suspected conventional diagnosis of trigeminal-mediated headshaking (TMHS) was made. A traditional Chinese veterinary medicine (TCVM) clinical exam was performed. The horse had a Wood personality with a slight dry tongue and deep strong pulse. Palpation of the head and multiple acupoints demonstrated sensitivity. The TCVM pattern diagnosis was Liver Qi Stagnation with Liver Heat, Stagnation of Qi in the Upper Burner (Shang Jiao) and Wind-Heat. Electro-acupuncture treatment was considered but due to safety concerns associated with the horse’s Wood personality, dry needle acupuncture (DNAP) was instituted instead. Acupoints stimulated included: LIV-3, GB-41, BL-18, Da-feng-men, BL-12, GB-20 and BL-17. Treatment also included food therapy (i.e. green vegetables) and a face mask was introduced. Marked clinical improvement was reported by the owner after the first DNAP treatment. One week later, a second DNAP treatment was performed using LIV-3, GB-41, BL-18, Da-feng-men and GB-20. A Spleen Qi Deficiency was diagnosed 3 weeks after the second acupuncture session. This was successfully treated with DNAP at ST-36, BL-20, SI-9 and GB-20. The horse received a total of three acupuncture treatments over the course of a month and then successfully maintained on low stress handling/training practices, along with external protection (i.e. face-nose mask); which has allowed this sport horse to currently train and compete on a regular basis at expected levels.