Headaches are common in healthcare staff using PPE


By Michael Woodhead

21 Apr 2020

PPE-associated compression headaches are becoming a problem for healthcare staff working in COVID-19 risk areas, neurologists in Singapore have shown.

More than 80% of healthcare workers who wore PPE items such as N95 face masks and protective goggles during clinic shifts developed new-onset headache or exacerbation of their pre-existing headache disorders, a study of staff at the National University Hospital, Singapore, found.

In a cross-sectional study of 158 healthcare workers in high risk areas for COVID-19, neurologists found that 128 (81%) developed de novo PPE-associated headaches. All the headaches were described as bilateral in location and were associated with mask use with or without goggles.

The location of the pain on the scalp, forehead or face aligned with the points of contact of the masks and goggles, and was described as a sensation of pressure or heaviness, and sometimes as a throbbing or pulling pain.

The headaches were typically episodic, of 1-4 days duration and were rated as mild to moderate in 71% of cases. In 83% of cases, staff reported that PPE-associated headaches resulted  in a “slight decrease” in work performance.

In almost all staff the headache resolved spontaneously after removing the mask and goggles. Most (69%) reported taking no analgesics for the PPE-headache, with the minority taking paracetamol or NSAIDs.

The main factors independently associated with PPE-associated headaches were a pre-existing primary headache diagnosis (Odds Ratio = 4.20; p = 0.03) and combined PPE usage for more than four hours per day (OR 3.91; p = 0.012).

Over the 30 day survey period, staff donned the N95 face mask and goggles for around 18 days, with a mean of six hours per day. Staff working in the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards (7.0 vs 5.2 hours) or medical ICU (2.2 hours).

Most of the staff surveyed were young, (78% were aged 21-35 years) and were predominantly nurses (65%) and doctors (32.3%). About a third (29.1%) had pre-existing primary headache diagnosis. Of these, 91.3% either “agreed” or “strongly agreed” that the increased PPE usage had affected the control of their background headaches since the COVID-19 pandemic, and this affected their level of work performance.

The authors of the study said their findings confirmed other reports of compression headache associated with PPE use, which could contribute to staff poor performance and burnout when combined with sleep deprivation, physical and emotional stress, irregular meal times and inadequate hydration.

The pain and discomfort was likely caused by excessive tightness of mask and goggle straps as well as thermal discomfort, causing a build-up of moist warm air inside the mask and googles, they suggested. Therefore, the fitting of N95 masks and goggles should also include adjustment for comfort as well as fit, they advised.

“The magnitude of this condition is clinically significant and might worsen if the current outbreak spreads widely and stays for a longer time, affecting the work performance of healthcare workers. Perhaps, better strategies are needed for designing various personal protection equipment and reducing their exposure time by healthcare workers,” they concluded.

The findings are reported in the journal Headache.

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