Localized Head and Facial Cooling under Thermoneutral Conditions: Trigeminal Sensory Pathways, Autonomic Responses, and Cognitive Performance-A Narrative Review

Abstract

Background: In naturopathy, cold treatments applied to the head and face, such as cold compresses, head packs, and ice massages, are commonly practised. These treatments have a distinct physiological basis compared to whole-body cold exposure, which can impair cognitive performance. Cooling the face specifically triggers trigeminal nerve pathways, resulting in an autonomic response through the vagus nerve. Increased vagal activity has been associated with attention and working memory, although a direct cognitive benefit from facial cooling has not been established. However, the impact of localized cooling on cognitive performance in thermoneutral settings has not been thoroughly examined. Objective: To identify clinical implications and address safety concerns, this review synthesises evidence concerning the trigeminal sensory pathways, autonomic responses, and cognitive effects associated with localized head and facial cooling in thermoneutral environments. Methods: A literature search was conducted in PubMed, Scopus, Google Scholar, and ScienceDirect for English-language studies published up to August 2026. Animal studies were excluded. Results: The face is one of the most cold-sensitive regions of the body. Cooling the forehead or face consistently lowers heart rate and increases indices of cardiac vagal activity. Facial cooling also leads to sympathetic co-activation with a modest rise in blood pressure, reduces cortisol responses to acute psychosocial stress, and slightly increases or maintains cerebral blood flow velocity. Naturopathic ice massage of the head and spine shifts heart rate variability towards vagal dominance. Whole-body and painful cold impair attention and executive working memory. Conclusion: Through neurovisceral integration, localised head and facial cooling elicits trigeminal–vagal responses and may reduce stress reactivity, providing a plausible pathway through which attention and working memory could be influenced. However, direct evidence of cognitive improvement following localised cooling under thermoneutral conditions is lacking. Standardised cooling conditions, validated cognitive tests, and adequately powered, sham-controlled studies are necessary.