Kamleshun Ramphul, Stephanie G. Mejias, Yogeshwaree Ramphul

1 Department of Pediatrics, Xinhua Hospital Aff iliated to the Shanghai Jiao Tong University School of Medicine, Shanghai, China 2 University Iberoamericana UNIBE School of Medicine, Santo Domingo, The Dominican Republic

3 Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius

Dear editor,

Coronavirus disease 2019 (COVID-19) is a highly infectious disease. By March 10, 2020, COVID-19 was in over 109 countries having infected over 113,702 people.[1]As the number of deaths keeps rising and with no vaccine,many countries are experiencing one of the most challenging times in their history.

We conducted a meta-analysis to understand the role of headache as a clinical presentation with the severity of COVID-19. Articles published in English and Chinese were searched on PubMed. Each result was carefully screened,and only articles comparing the severity of COVID-19 used for our study. We used R-software (https://www.r-project.org/) to conduct the meta-analysis and design a forest plot.

After a thorough evaluation, seven articles[2-8]were retained. Totally 1,495 patients presented as non-severe COVID-19 and 192 had headaches (Figure 1). Meanwhile, 94 of the 650 severe COVID-19 cases had a headache. The odds ratio (OR) was calculated as 1.32 (95% confidence interval[CI] 0.98–1.80). We conclude that the clinical presentation of headache in a COVID-19 patient cannot be used as a prognostic factor for severe COVID-19 disease. However, further analysis is recommended in the future with a larger sample size.

Figure 1. Association of headache with severity of COVID-19.

Funding:None.

Ethical approval:Not needed.

Conf licts of interest:There is no conf lict of interest in this study.

Contributors:KR proposed the study, and wrote the first draft.All authors read and approved the f inal version.