Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic

Abstract

BackgroundHealthcare workers in frontline during the coronavirus 19 disease (COVID-19) pandemic are mandated to wear specific personal protective equipment (PPE) including high filtrating masks and/or eye protection during extended period of time. Compressive headaches secondary to PPE use including N95 masks have been reported. We aim to describe subtypes of headache related to PPE use in our hospital in Casablanca and working condition factors associated with it. MethodsWe conducted a cross-sectional study among healthcare workers in frontline at Cheikh khalifa International University Hospital, using an online questionnaire. We collected demographic data, comorbidities and previous headaches history. Data about working conditions during pandemic, type and duration of PPE use were described. We calculated the prevalence of De Novo or an aggravated headache among healthcare workers. We studied correlations between PPE related headaches and working conditions and trends in PPE use during the pandemic. Finally, we described the overall discomfort related to PPE use. ResultsA total of 155 healthcare workers responded to the questionnaire. The N95 masks were the most used type (95.5%) associated with an eye protection in 61.3%. The overall prevalence of headache related to PPE was 62%. It was experienced De Novo in 32.9%, while it was an aggravation of pre-existing headache in 29%. Working more than 8 hours per shift during the pandemic was correlated to De novo headache (p = 0.008). The profession of doctor and working more than 12 hours per shift were correlated to aggravated headache (p = 0.02, p = 0.023). Healthcare workers experienced moderate discomfort, blurred vision and reduced concentration. They judged their professional performance mildly reduced by the use of PPE. ConclusionThe increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline either De novo or as an aggravation of pre-existing one. Working conditions have the greater impact on generating these types of headaches more than any preexisting comorbidity. These findings should be considered to accommodate health care professionals to increase efficacy and adherence to protective measures during pandemic.

Headache Related to PPE Use during the COVID-19 Pandemic

“…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 ).…”

“…Headache is usually bilateral with the experienced discomfort localising to areas where the protective respirator and eyewear, and their accompanying straps, makes contact upon the head, face and neck (see Fig. 1 ) [ 25 ••, 36 •, 38 •]. Headache quality .…”

“… Headache duration . Attacks have been reported to range from <30 min to 2 h [ 25 ••, 34 •, 36 •, 38 •]. Associated symptoms .…”