Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

• Published in: Headache Vol. 60; no. 5; pp. 864 - 877
• Main Authors: Ong, Jonathan J.Y., Bharatendu, Chandra, Goh, Yihui, Tang, Jonathan Z.Y., Sooi, Kenneth W.X., Tan, Yi Lin, Tan, Benjamin Y.Q., Teoh, Hock‐Luen, Ong, Shi T., Allen, David M., Sharma, Vijay K.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2020
• Subjects: Adult; coronavirus disease; coronavirus disease 2019; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; Coronaviruses; COVID-19; Cross-Sectional Studies; Diagnosis; Disorders; Emergency medical care; Emergency medical services; Emergency response; Eyewear; face mask; Female; goggles; Headache; Headache - epidemiology; Headaches; Health care; Health Personnel - statistics & numerical data; healthcare workers; Humans; Infectious diseases; Male; Medical personnel; N95; Pandemics; Pandemics - prevention & control; personal protection equipment (PPE); Personal protective equipment; Personal Protective Equipment - adverse effects; Physicians; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; Protective equipment; Risk analysis; Risk factors; Singapore - epidemiology; Surveys and Questionnaires; Viral diseases; Workers; Young Adult; Singapore; face mask; goggles; coronavirus disease 2019; eyewear; healthcare workers; personal protection equipment (PPE); coronavirus disease; N95; headache
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.13811

Background Coronavirus disease 2019 (COVID‐19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high‐risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients. Objectives We sought to determine the risk factors associated with the development of de novo PPE‐associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID‐19 on pre‐existing headache disorders was also investigated. Methods This is a cross‐sectional study among healthcare workers at our tertiary institution who were working in high‐risk hospital areas during COVID‐19. All respondents completed a self‐administered questionnaire. Results A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21‐35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre‐existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE‐associated headaches. A pre‐existing primary headache diagnosis (OR = 4.20, 95% CI 1.48‐15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35‐11.31; P = .012) were independently associated with de novo PPE‐associated headaches. Since COVID‐19 outbreak, 42/46 (91.3%) of respondents with pre‐existing headache diagnosis either “agreed” or “strongly agreed” that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance. Conclusion Most healthcare workers develop de novo PPE‐associated headaches or exacerbation of their pre‐existing headache disorders.