Facemask headache: a new nosographic entity among healthcare providers in COVID-19 era

Abstract

Background SARS-CoV-2 is a novel infectious agent causing coronavirus disease 2019, which has been declared as pandemic in March 2020. Personal protective equipment has been mandatory for healthcare workers in order to contain the outbreak of pandemic disease. Mild neurological disturbances such as headache have been related to the extensive utilization of facemask. This study aims to examine headache variations related to the intensive utilization of facemask among a cohort of healthcare professionals in a setting of low-medium risk of exposure to SARS-CoV-2. Methods This is a cross-sectional study among healthcare providers from different hospital and clinics in Italy. Each participant completed a specifically designed self-administered questionnaire. Headache features and outcome measures' change from baseline were evaluated over a 4-month period, in which wearing facemask has become mandatory for Italian healthcare workers. Results A total of 400 healthcare providers completed the questionnaire, 383 of them met the inclusion criteria. The majority were doctors, with a mean age of 33.4 ± 9.2 years old. Among 166/383 subjects, who were headache free at baseline, 44 (26.5%) developed de novo headache. Furthermore, 217/383 reported a previous diagnosis of primary headache disorder: 137 were affected by migraine and 80 had tension-type headache. A proportion (31.3%) of these primary headache sufferers experienced worsening of their pre-existing headache disorder, mainly for migraine frequency and attack mean duration. Conclusions Our data showed the appearance of de novo associated facemask headache in previous headache-free subjects and an exacerbation of pre-existing primary headache disorders, mostly experienced by people with migraine disease.

Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study

“…New PPE-associated headaches were associated with the presence of pre-existing primary headaches and combined PPE usage > 4 h/day [ 29 ]. Additionally, a study consisting of 383 Italian healthcare providers found that 44 (26.5 %) developed de novo facemask-associated headache [ 30 ]. In our study, 31.8 % were involved in frontline work, and 12.5 % were healthcare providers.…”

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.…”

“…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 ).…”

“… Headache quality . Usually a ‘pressure’, ‘heaviness’ or ‘pulling’ sensation, although some may experience a ‘throbbing’ headache [ 25 ••, 33 •, 36 •]. Headache intensity .…”