We investigated the prevalence of mask/PPE associated headache among Bangladeshi physicians during COVID 19 pandemic along with the risk factors and headache characteristics. Headache severity was assessed by the Headache Impact Test . This is a cross-sectional, online Google form based study among 200 physicians from different hospitals in Dhaka conducted from December 2020 to April 2021. We compared characteristics of 'mask associated headache' and 'no headache' groups as well as of groups with and without previous headache. Independent factors associated with headache occurrence and severity were identified. Majority participants were male (129, 64.5%) with mean (SD) age of 35.4(7.5) years. Filter masks (146, 73%) were mostly used along with other PPE (139, 69.5%). Headache prevalence was 71% and 59.9% developed new onset headache. Doctors with a pre-existing primary headache disorder [OR: 5.40, 95% CI: 2.03-14.41; P=0.001] had the highest risk of developing headache. Headache occurrence was independently associated with working in the COVID unit [OR: 2.47, 95% CI: 1.18-5.18; P=0.017] and combined mask & other PPE usage [OR: 2.35, 95% CI: 1.13-4.84;P=0.021] for ≥ 6months [OR:2.06, 95%CI:1.05-3.99; P=0.036]. Most headaches were dull aching (33.8%), lasted for 1-4 hours (58.5%) & relieved within 1 hour of mask removal (43.6%). Headache Impact Test (HIT-6) score was substantial too severe among the doctors with previous headaches [OR: 2.91, 95%CI: 1.43-5.92; P=0.003] and those having moderate to severe stress levels [OR: 2.56, 95%CI: 1.19-5.55; P=0.017]. Most physicians with previous primary headache develop mask/PPE associated headache with considerable impacts on daily life.

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