- Effectiveness of Cooling Therapy for Relieving Migraine Symptoms in Adults: A Systematic Review and Meta-Analysis
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Brian Donnelly, Sondos Eladawi, Benjamin R. Wakerley
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Received June 11, 2026 Accepted July 11, 2026 Published online August 20, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0028
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 Abstract
- Purpose: To evaluate the effectiveness of cooling therapy for relieving migraine symptoms in adults.
Methods
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched from inception. Randomised controlled trials (RCTs) and observational studies evaluating cooling-based interventions in adults with migraine were eligible. The outcomes assessed were headache intensity and migraine-associated nausea. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 and Risk of Bias in Non-randomised Studies of Interventions tools. Data were pooled using Review Manager version 5.4, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Results
Eleven studies met the inclusion criteria, comprising five RCTs and six non-randomised studies. The interventions included maxillary cooling, neck cooling, cold packs, cold wraps, and intranasal evaporative cooling. Pooled analyses indicated that cooling therapy reduced headache intensity compared with placebo or standard care (standardised mean difference [SMD], –1.18; 95% confidence interval [CI]: –2.09 to –0.27; p=0.01). A smaller reduction in migraine-associated nausea was also observed (SMD, –0.54; 95% CI: –0.97 to –0.12; p=0.01). Substantial heterogeneity was present across studies. The tolerability of intranasal cooling devices varied, with higher airflow settings associated with greater discomfort and higher withdrawal rates. The certainty of the evidence was low to very low because of methodological limitations, heterogeneity, and imprecision.
Conclusion
Cooling therapy may reduce headache intensity and migraine-associated nausea during acute attacks and could serve as an adjunct to established migraine treatments. However, larger, methodologically rigorous RCTs are needed to determine the most effective cooling methods and protocols and to establish their longer-term clinical benefits.
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