Your cat will not cry the way a person does. When a dog is hurting, he limps, whines, or pants. When a cat is hurting, she often goes quiet, hides, and keeps a perfectly still face. That stillness is not a sign everything is fine — it is why cat pain is so often missed at home.
That is where the Feline Grimace Scale comes in. Developed by scientists at the University of Montreal and published in 2019 in the journal Scientific Reports, it identifies five facial features that change when a cat is experiencing acute (sudden or short-term) pain, such as after surgery. Each feature is scored 0 (not present) to 2 (clearly present), for a total of 0 to 10 — with 4 or higher suggesting the cat may need pain treatment.
The scale was designed for veterinary professionals and is now a trusted pain-assessment tool in veterinary medicine. But the five facial cues it measures are things any attentive owner can learn to notice. This guide explains them in everyday terms. The key rule: the scale is an assessment aid, not a diagnosis. Spotting a grimace does not tell you why your cat hurts; it tells you it is time to call the vet.
How the Scale Works: Five Action Units
The Feline Grimace Scale looks at five “facial action units” — five small windows into how your cat is feeling. No single feature proves pain on its own; vets score all five together, because the pattern across the whole face is what matters.
Before you start observing, give your cat a few minutes to settle. Pain scoring works best when your cat is resting in a familiar place — not during playtime or right after a stressful event.
1. Ear Position: Flattened or Pulled Back
A comfortable, relaxed cat holds her ears upright and facing forward or slightly to the side. A cat in pain often rotates her ears outward and flattens them.
What to look for: Compare your cat’s ears now to how they normally look. Do they seem pushed down or angled outward like airplane wings? Are they pinned tighter than usual while she rests?
Example scenario: Milo usually naps with his ears perked toward the living room. One evening after a vet visit, his owner noticed his ears stayed pinned flat while he sat hunched in his cat tree. Combined with other facial changes, the picture warranted a call to the clinic — where the vet adjusted his pain medication.
Flattened ears can also mean fear or stress, so context matters. If they flatten only when the vacuum cleaner runs, that is probably fear. But if the flattening lingers when everything is calm, note it alongside the other signs in our guide on how to tell if your cat is in pain.
2. Orbital Tightening: The Eye Squint
“Orbital tightening” is the technical name for squinting or partially closed eyes. Fully open, relaxed eyes score 0; partially narrowed eyes score 1; clearly squinted or nearly closed eyes score 2.
What to look for: Is your cat keeping her eyes half-shut even in normal light, or is one eye more closed than the other? A cat in pain may have a “sleepy” or glazed look that does not match the time of day.
Example scenario: A shelter volunteer noticed a normally bright-eyed tabby named Pepper kept her eyes at half-mast all afternoon, with slightly flattened ears too. The volunteer’s notes helped the shelter vet identify a dental disease flare-up — the kind of quiet, chronic problem that is easy to miss because cats rarely complain.
One squinted eye alone can also signal an eye injury or infection, and both need veterinary attention quickly. Read it as part of the whole-face picture, not a standalone verdict.
3. Muzzle Tension: A Tight, Pinched Snout
The muzzle is the area around your cat’s mouth and nose. On a comfortable cat, it looks soft and relaxed. When a cat is in pain, the muscles around the nose and mouth tense up, making the muzzle look pinched, wrinkled, or “pursed.” Some owners describe this as a “sad” or “worried” look.
What to look for: Compare your cat’s resting face to how she looks when relaxed and happy. Does her snout look tighter, with the corners of her mouth drawn down or pulled in?
Example scenario: After a routine spay, a cat named Luna was recovering at home on pain medication. Her owner noticed her muzzle looked tense and her mouth corners were pulled tight on the second evening. A quick call to the vet led to an adjusted dose, and within hours, Luna’s face relaxed.
This is one of the subtler cues and easiest to miss if you do not know your cat’s relaxed face — so pay attention to her normal resting expression on ordinary days, which becomes your baseline.
4. Whisker Position: Straight, Flat, or Pulled Forward
This cue surprises many owners. A relaxed cat’s whiskers arc gently outward and curve away from the face. Grimace-scale whiskers are pulled straight out, flattened against the face, or pushed forward.
What to look for: Look at the whisker fan from the side. Do the whiskers look rigid and straight instead of softly curved — pointing forward like antennae, or pressed back along the cheeks?
Example scenario: An older cat named Oliver began eating more slowly, and his owner assumed he was just getting picky with age. But photos taken over a few weeks showed his whiskers consistently pulled forward, with a tense muzzle and squinted eyes. The vet found painful tooth resorption — the whiskers had been telling the story before the appetite change did.
5. Head Position: Low, Hanging, or Tilted Down
A comfortable cat holds her head level with or above her shoulders. A cat in pain often lets her head hang low, tilting it down toward her chest.
What to look for: When your cat is sitting or lying still, is her head held lower than usual? Does her chin rest lower, or does her head hang while she sits upright?
Example scenario: Bella, a two-year-old indoor cat, seemed fine after a mild fall — but her owner noticed she kept her head hanging low in her favorite sunny spot, something she never did before. Combined with partially squinted eyes, the picture justified a vet visit, where an X-ray found a painful bruise that needed medication.
Head position is most meaningful when your cat is at rest. A cat sniffing the floor has her head down for a reason — so watch for the low head during quiet moments.
Putting It Together: A Simple At-Home Observation Routine
You do not need formal math at home, and never treat the score as a diagnosis. A gentle routine can make you a better observer:
- Observe during quiet time. Pick a calm moment when your cat is resting in a familiar spot.
- Check each feature in your head. Ears, eyes, muzzle, whiskers, head — “normal,” “a bit off,” or “clearly different.”
- Look for a pattern, not one feature. One squinted eye on a windy day is different from flattened ears + squinted eyes + tense muzzle together.
- Write it down. A quick phone note with the date (“ears flat, eyes half-closed, since morning”) helps your vet more than “she’s been acting weird.”
- Compare to her baseline. Keep one or two photos of your cat’s relaxed, happy face as a reference.
Remember: the clinical threshold of 4 out of 10 is meant for trained professionals alongside a physical exam. Your job at home is not to score your cat — it is to notice changes and report them.
What NOT to Do
Learning the grimace scale makes you a sharper observer, but it comes with real responsibilities. Avoid these common mistakes:
- Do not use the scale to diagnose. A grimace tells you something may be wrong. It does not tell you what or how serious it is. Only a vet with a physical exam (and sometimes bloodwork or imaging) can diagnose.
- Do not treat your cat at home. Human painkillers such as ibuprofen and acetaminophen are toxic to cats — even small amounts can cause organ failure. Never medicate without direct veterinary instruction.
- Do not wait and see with emergencies. If your cat shows facial pain signs alongside serious symptoms — open-mouth breathing, collapse, inability to move, crying out, a swollen belly, or no urine output — go to the vet right away.
- Do not rely on the scale alone. Changes in appetite, litter box habits, grooming, and energy are just as important. If something feels off, trust your instincts and call the clinic.
- Do not assume a low “score” means no pain. Chronic pain can look different from acute pain, and some cats suppress expressions in unfamiliar settings. The absence of a grimace is not proof of comfort.
When to See a Vet
Use this section as your action guide. Call your vet promptly if you notice a grimace pattern — flattened ears, squinted eyes, tense muzzle, changed whiskers, or a hanging head — in any of these situations:
- After surgery or a medical procedure. Post-operative pain is exactly what the scale was built to assess. If your cat’s face looks tense the day after a procedure, call the clinic the same day.
- After an injury or a fall. Even if your cat seems to be moving normally, facial pain cues may be the only visible sign of a sprain or bruise.
- With sudden behavior changes. Hiding, not eating, avoiding the litter box, or refusing to be touched — combined with a grimace — deserve a prompt appointment.
- In senior cats. Older cats develop arthritis, dental disease, and other painful conditions gradually. A slowly worsening expression over weeks or months is a common, overlooked sign.
- When it does not resolve. A grimace that lasts more than a few hours, or that keeps returning, should always be checked.
Pain can also travel with other symptoms. A cat with ongoing digestive upset may show facial tension too — if that sounds familiar, our guide on why cats get diarrhea and what to do covers possible causes and next steps, and repeated sneezing with signs of discomfort can point to respiratory irritation that also deserves veterinary attention.
Frequently Asked Questions
Is the Feline Grimace Scale only for vets, or can I use it at home?
It was designed and validated for veterinary professionals, and the formal scoring belongs in a clinical setting. At home, use the five facial cues as an awareness tool — a way to notice possible pain and describe it clearly to your vet. No score needed; just notice changes.
Can I use the grimace scale on my dog?
No. The scale was developed specifically for cats, and each species has different facial anatomy and pain expressions. Dogs have their own validated pain tools, such as the Glasgow Composite Pain Scale. The principle — watch the face, look for patterns, call the vet — applies to both, but the specific action units do not.
What score means my cat needs pain medication?
In the research, a total score of 4 out of 10 or higher was the threshold suggesting pain that should be treated — but that decision belongs to your veterinarian. Never give your cat pain medication on your own based on a score. Many common painkillers are dangerous or fatal for cats, so the medication decision always requires a vet.
Does a grimace always mean pain?
Not necessarily. These facial features can also appear with fear, stress, or non-painful illness. The scale was validated for acute pain and works best alongside your cat’s behavior, appetite, and a vet exam. A grimace is a signal, not a conclusion.
My cat’s face looks tense but she is still eating and playing. Should I worry?
Brief, mild changes can happen for many reasons — a stressful day or a new smell in the house. But if the tense expression persists for hours, returns repeatedly, or appears alongside any other behavior change, call your vet. Cats are experts at masking discomfort, so a persistent grimace in an otherwise “normal” cat is still worth reporting.
A Kinder Way to Watch Over Your Cat
The Feline Grimace Scale did something remarkable: it turned “I just feel like she’s hurting” into something observable, describable, and useful. You may never need to score your cat formally. But the next time she is sitting quietly with her ears a little too flat and her eyes a little too narrow, you will know what you are looking at — and you will know what to do about it.
Learning your cat’s face is one of the kindest things you can do for her. Notice the five features, watch for patterns instead of single signs, keep a few notes, and always route what you find to your veterinarian. Your cat cannot tell you she hurts — but if you know how to read her face, she does not have to.