MIGRAINE SYMPTOMS AND ASSOCIATION OF TRIGGERS, COPING STRATEGIES AND CLINICAL CHARACTERISTICS WITH COVID-19 DIAGNOSIS AMONG UNIVERSITY STUDENTS IN PENINSULAR MALAYSIA: A CROSS-SECTIONAL STUDY Introduction: Differentiating between migraine and COVID-19 headaches is essential for better treatment. Evidence-based research during the COVID-19 pandemic has found that university students are more likely to experience migraine. Migraine can affect academic performance, sleep pattern, social and emotional well-being if left untreated or misdiagnosed. This study aimed to determine the prevalence of migraine symptoms and the association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis. Methods: This cross-sectional study was conducted across higher educational institutions in Peninsular Malaysia. Convenience sampling was applied to recruit full-time university students. A reliable and validated instrument was used to evaluate demographic data, migraine symptoms, triggers, coping strategies and clinical characteristics of migraine (frequency, intensity, severity and duration) during COVID-19 diagnosis. Results: The response rate was 98.3%, where 485 out of 493 responses were analysed. The prevalence of migraine was 35.9% (n=174). None of the triggers, coping strategies and clinical characteristics of migraine were significantly associated with COVID-19 diagnosis. Conclusion: The university students in Peninsular Malaysia showed a considerable prevalence of migraine symptoms. During the pandemic, the common triggers for existing symptoms were stress and a lack of sleep (combined triggers). The coping strategy adopted by most of the university students was lifestyle changes and in the COVID-19 positive group maladaptive coping strategies were adopted indicating the need for further investigation.

RESPONSE TO: HOW THE PANDEMIC AFFECTED THE FREQUENCY, TYPE, AND INTENSITY OF MIGRAINES IN STUDENTS We appreciate the opportunity to further elaborate on the concerns raised regarding our recent publication entitled ‘Migraine symptoms and association of triggers, coping strategies and clinical characteristics with COVID-19 diagnosis among university students in Peninsular Malaysia: A crosssectional study’.1 We value the feedback provided and are pleased to address the points mentioned.2.