Objective To explore the correlation between cognitive function and serum 5-hydroxytryptamine （5-HT） and matrix metalloproteinase-9 （MMP-9） in patients with vestibular migraine （VM）. Methods Sixty VM patients at the Jining First People's Hospital from May 2021 to January 2023 were selected as the VM group， and 60 healthy individuals who underwent physical examinations during the same period were selected as the control group. The Mini-Mental State Examination （MMSE） was used to evaluate the cognitive function of two groups of subjects， and the serum levels of 5-HT and MMP-9 were compared between the two groups of subjects. The frequency， duration， Dizziness Handicap Inventory （DHI）， and Visual Analogue Scale （VAS） of VM patients were collected. Spearman， Pearson correlation， and multiple linear regression were used to analyze the correlation between migraine duration， frequency， DHI score， VAS score， serum 5-HT， MMP-9 levels， and MMSE score in VM patients. Results The MMSE score of the VM group was （24.33±2.67）， and the serum 5-HT level was （335.48±91.52） μg/L， lower than the control group's （28.90±1.39）， （515.12±127.57） μg/L， the differences were statistically significant （t=-11.91， -8.86； P＜ 0.001）. The serum MMP-9 level in the VM group was （58.88±11.32） μg/L， higher than the control group （35.94±7.40） μg/L， the difference was statistically significant （t=13.14， P ＜ 0.001）. The serum 5-HT levels in VM patients were negatively correlated with the duration and frequency of vestibular migraine （r=-0.41， -0.61； P ＜ 0.05）， and positively correlated with MMSE scores （r=0.40， P ＜ 0.05）， with statistically significant differences. The serum MMP-9 level was positively correlated with the frequency of vestibular migraine （r=0.70， P＜ 0.05）， and negatively correlated with MMSE score （r=-0.47， P＜ 0.05）， and the differences were statistically significant. Multiple linear regression analysis showed that age， MMP-9 level， duration of vestibular migraine， VAS score， serum 5-HT level， and DHI score were the influencing factors of cognitive function in VM patients， and the differences were statistically significant （P＜ 0.05）. Conclusions There is a correlation between serum levels of 5-HT and MMP-9 and cognitive function in VM patients.