Cognitive impairment in vestibular migraine: a PubMed-based systematic review and meta-analysis.

BACKGROUND: Vestibular migraine (VM) is a leading cause of recurrent vertigo, and many patients describe cognitive symptoms such as "brain fog," slowed thinking, and forgetfulness; however, the magnitude and consistency of objectively measured cognitive impairment in VM have not been clearly quantified. We therefore conducted a PubMed-only systematic review (2010-2025; English; humans) of observational studies reporting quantitative behavioral cognitive outcomes or explicit impairment thresholds in adults with VM. Two reviewers independently extracted data and assessed the risk of bias using ROBINS-I. Continuous outcomes were pooled as standardized mean differences (SMD; Hedges g; random-effects REML), while the prevalence of study-defined cognitive impairment in VM cohorts was synthesized using the Freeman-Tukey transformation; when required, medians and measures of dispersion were converted to means and standard deviations. RESULTS: Six studies met the inclusion criteria, of which four contributed to the primary meta-analysis (VM n = 208; healthy controls [HC] n = 180). Compared with HC, adults with VM demonstrated poorer global cognition (SMD -0.92, 95% CI -1.13 to -0.70; I2 = 8%), with a prediction interval of -1.38 to -0.45. Executive function, indexed by Stroop performance in two studies, also suggested a large deficit (SMD + 1.55, 95% CI 0.77-2.33; I2 = 79%), though this pooled estimate should be interpreted cautiously as an exploratory signal due to the high heterogeneity driven by differing Stroop metrics. Across VM cohorts, the pooled prevalence of study-defined cognitive impairment was 0.74 (95% CI 0.66-0.81; I2 = 0%). CONCLUSION: Based on this focused, single-database rapid review, current evidence suggests adults with VM may exhibit moderate-to-large decrements in global cognition and executive control, supporting the consideration of cognitive screening and multidisciplinary management in routine VM care. Future work should prioritize standardized cognitive outcomes and mechanistic studies to clarify causal pathways and improve clinical translation. SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/projects/, Identifier, INPLASY2025100115.