Purpose: Cooling the head, face, and neck can have strong perceptual effects that contribute to improved performance. This systematic review aimed to determine the effect of cooling strategies targeting the head, face, and neck on physical and cognitive performance, determine any associated physiological and perceptual responses, synthesize adverse events, and provide practical applications. Methods: We conducted a systematic review and multilevel meta-analysis, adhering to PRISMA guidelines. Studies that investigated the effect of cooling strategies targeting the head, face, or neck on a physical or cognitive task using a controlled trial design were included. Results: Sixty-three studies were identified, involving 618 participants (86.6% male). Cooling strategies included water-perfused devices (18.7%), phase-change neck collars (17.3%), fanning/cold air (14.7%), phase-change headwear (13.3%), ice/gel packs (13.3%), cold towels (5.3%), menthol application (4.0%), water spraying/dousing (4.0%), or a combination of strategies (9.3%). The effect of cooling on both self-paced and fixed-intensity exercise tasks was inconclusive; the 95% CI of the pooled effect was compatible with no effect and medium beneficial effects but not harmful effects. We were unable to pool cognitive data. Cooling reduced the skin temperature at the target site and improved thermal sensation and comfort. Effects on heart rate and core and mean skin temperatures were negligible. Adverse events were rare, and no intervention subgroup was superior. Conclusion: We recommend that athletes experiment with a range of head-, face-, and neck-cooling strategies, including using different doses and timings, to determine the optimal strategy for their individual and sport context.
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