Headache associated with the use of personal protective equipment during the COVID-19 pandemic: an international survey

Introduction. The COVID-19 pandemic and the use of personal protective equipment (PPE) in the healthcare setting provide a unique opportunity to study PPE-associated headaches (PPEAH). Subjects and methods. We conducted an online survey to assess the prevalence and clinical characteristics of PPEAH. The survey was voluntary, anonymous and addressed to medical and non-medical personnel. We used descriptive statistics and univariate and multivariate comparative analyses to identify factors associated with the development of PPEAH and its impact on work capacity. Results. Out of 886 respondents, 88% (780) reported wearing PPE. Most of them were physicians (81%), 52.4% of whom were women. The prevalence of PPEAH was 65.5% (511/780) and 73.8% (377/511) were de novo headaches. PPEAH was acute, oppressive, bifrontal and of moderate intensity, and subsided with the removal of the PPE. Accompanying symptoms were common, and migraine and/or dysautonomic features were highly prevalent. Female sex, age > 40 years, use of PPE > 6 hours/day and the combination of an N95 mask and goggles were associated with the occurrence of PPEAH. There were factors associated with a negative impact on the ability to work because of the PPEAH. Discussion. PPEAH may be a form of external compression headache (ECH); however, it has distinctive features that overlap with other primary and/or secondary headache disorders. Conclusions. PPEAH is prevalent and impacts on work-related activities. One subgroup presents characteristics not previously described in ECH.