Cognitive impairment in vestibular migraine: a PubMed-based systematic review and meta-analysis
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 208 participants or records.
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