Headaches Associated with Personal Protective Equipment - A Cross-sectional Study Amongst Frontline Healthcare Workers During COVID-19 (HAPPE Study)

Jy Ong, Jonathan; Bharatendu, Chandra; Goh, Yihui; Zy Tang, Jonathan; Wx Sooi, Kenneth; Lin Tan, Yi; Yq Tan, Benjamin; Teoh, Hock-Luen; Ting Ong, Shi; Allen, David M.; Sharma, Vijay K.

BACKGROUND: 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 amongst 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, p4 hours per day (OR 3 91, 95% CI 1 35-11 31;p=0 012) 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