Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study

Abstract

Objectives This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods A descriptive cross-sectional survey was conducted across Pakistan in June–July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received. Statistical Analysis Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant. Results A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99–0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94–3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47–10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05). Conclusion Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.

Headache Related to PPE Use during the COVID-19 Pandemic

“…The incidence of PPE-associated headaches amongst healthcare workers in the context of the COVID-19 pandemic ranges from 26.5%–90.7% [ 24 , 25 ••, 26 – 32 , 33 •, 34 •, 35 •, 36 •]. In comparison, a study amongst healthcare providers using the N95 face mask during the 2003 severe acute respiratory distress syndrome (SARS) epidemic in Singapore observed that new-onset face mask–associated headaches occurred with an incidence of 37.3% [ 37 ].…”

“…Since the start of COVID-19 in December 2019, there have been a total of 6 published studies specifically conducted to understand PPE-associated headache amongst healthcare workers (see Table 1 ) [ 25 ••, 33 •, 34 •, 35 •, 36 •, 38 •]. Based on these studies, several factors have been found to confer a greater likelihood of developing de novo PPE-associated headaches.…”

“…These include having a pre-existing primary headache diagnosis (e.g. migraine or tension-type headache) [ 25 ••, 34 •], engaging in shift-work lasting more than 8 h [ 38 •] or up to 12 h [ 23 , 38 •] at a stretch, and the use of a filter mask (as opposed to a surgical mask) [ 35 •]. The combined usage of PPE (N95 respirator and protective eyewear) for >4 h per day [ 25 ••] or the use being a healthcare worker (in particular being a nurse) or having a history of asthma was also found to correlate with the development of such headaches.…”

“…Recently published studies specifically looking at PPE-associated headache amongst healthcare workers during COVID-19 provide interesting insights into the phenotype of this unusual entity which until now has been infrequently reported [ 25 ••, 33 •, 34 •, 35 •, 36 •, 38 •] (see Table 1 ).…”

COVID-19: Were Public Health Interventions and the Disclosure of Patients’ Contact History Effective in Upholding Social Distancing? Evidence from South Korea

“…Social distancing measures along with personal protective equipment should be emphasized once countries start or decide to lift restrictions for the sake of their respective economy even though they are struggling to flatten the pandemic curve. 15 This is because such measures can at least delay the rapid spread and allow the healthcare system to save time and resources intended for expanding capacity in testing and medical treatment. In this challenging period, South Korea provides evidence that the pandemic can be contained with less aggressive restrictions.…”