Headache Medicine 2020, 11(3):55-56 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.16

Headache Medicine

Editorial

The Headache and adverse events due to the use of personal

protective equipment to combat Covid-19

Erlene Roberta Ribeiro dos Santos

Department of Collective Health at the Academic Center of the Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil.

Headache deserves specic attention in the context of the current health situation when it can be potentially as-

sociated with the use of three specic artifacts, during the Covid-19 pandemic, in which it is necessary to change

behavioral habits across the planet. Personal protective equipment such as a mask, face shield, and glasses for

healthcare professionals has never been more widespread. Personal protective equipment is already routinely used

in healthcare environments such as urgent and emergency services, laboratories, clinics, and hospitals. However,

in the context of the Covid-19 pandemic, the use for the protection of health professionals in the ght against the

coronavirus has been occurring for a long time for hours during work shifts.

These devices compress the scalp tissue

circumferentially and often leave pressure marks after its removal, as is often observed in the case of the mask.

This situation has affected the work environment of professionals who have been at the forefront of combat-

ing Covid-19 since December 2019, in units dedicated to the care of infected patients. Therefore, we won-

der about the need and importance of exploring the adverse event of prolonged use of personal protective

equipment such as mask, face shield, and goggles associated with the triggering of external pressure headaches.

Personal protective equipment has fundamental importance to avoid contagion in the treatment of patients infected

with the coronavirus. However, the use of caps, masks, face shields, eye protection glasses, and other accessories

necessary to comply with the clinical protocols dened for patient care has been drawing attention to an import-

ant issue of occupational health, as mandatory and uninterrupted times for hours of the work shift can generate

signicant compression

in the innervated tissue of the head and physical changes.

A worldwide study carried out via web

, in April 2020, reveals a description of adverse effects on the use of

protective equipment associated with the period of more than 4 uninterrupted hours carried out with professionals

working in intensive care units. Of the 2,711 responses to the questionnaire submitted online, 1,797 (67%) doctors,

744 (27%) nurses, and 170 (6%) paramedics were identied. The majority (1,557; 58%) reported the routine use

of mask type FFP2 or N95, long-sleeved waterproof aprons (1,623; 67%), and face shields (1,564; 62%). The

adverse effects were associated with variables such as the duration of use in the longest shift, feeling of discomfort

due to heat, sensitivity in areas of pressure, headache, and extreme exhaustion.

The etiology of this type of headache is triggered by external pressure resulting from the sustained compression

of the soft tissues of the epicrania, associated with the use of the equipment on the head

, which can lead to work

disability, direct costs mainly related to absenteeism, indirect costs often linked to the use of medications, both

individual and health systems. Also, other elements such as the high level of exposure to stressors, such as the

news of deaths by Covid-19 that occurred with patients and coworkers, can increase the frequency of crises and

illness processes associated with other comorbidities.

1, 4

erlene.santos@ufpe.br

Received: September 15, 2020

Accepted: September 19, 2020

Edited by

Marcelo Moraes Valença

Keywords:

Headache

Covid-19

Mask

Face shield

Protective goggles

ASAA

Santos ERR

The Headache and adverse events due to the use of personal protective equipment to combat Covid-19

A recent study

presents evidence about the N95 face mask that

efciently protects against respiratory droplets. On the other hand, it

highlights evidence showing adverse effects such as excoriation on

the bridge of the nose, which can be caused by the excessive pres-

sure and hardness of the equipment's metal clip, causing a painful

sensation and post-use marks for long periods on the facial tissues.

1, 5

Another previous study measured the impact of headaches associ-

ated with prolonged use of N95 masks as a risk factor, with 217

health workers, revealing that 79/217 (37.3%) reported headache

associated with the use of N95 mask, 26/217 (32.9%) reported

headache frequency more than six times a month, 7.6% requested

sick leave due to work disability (ranging from 1 to 4 days, with an

average of two days), 47/217 (59.5%) resorted to crisis abortion

medication and 4/2,017 used preventive medication during the

period of use of the equipment, showing positive statistical signi-

cance for the association of pre-existing headaches and continuous

use of the N95 face mask.

The pressure exerted by the facial protector, depending on the elas-

tic adjustment, can pressure the region of the epicranial muscles

which are areas of hypersensitivity and can reproduce pain symp-

toms, which can also enhance the headache characteristics. The

headaches that occur in professionals who use masks, face shield,

and goggles for eye protection may arise due to the pressure of

the strap in the neck or the occipital area, on the supercial nerves,

which may aggravate an underlying cervical tension and potenti-

ate the headache associated with the use of the three equipment

combined simultaneously or alternating.

For those who already suffer from primary headaches such as

migraine, the damage can be greater, as the continued use of the

accessory by pressing on sensitive areas for an extended period

can increase the chance of triggering a crisis.

It is feasible to point out that there are few studies on headaches

due to external pressure from the use of a band surrounding the

head region, hat

, helmets

and tight swimming goggles that are

pointed out as the cause of constant and intense pain in the area

pressed by the object. This evidence already points to the impor-

tance of headache potentially triggered by the use of adornments

that generate pressure in the pericranial tissue.

Because of the complex current scenario with efforts aimed at com-

bating Covid-19, this brief article warns of the need for more in-depth

research on the adverse events potentially triggered by the three most

used personal protective equipment in health services (mask, face

shield and eye protection glasses), as daily and continuous exposure

for prolonged periods by professionals can bring consequences.

Based on these notes, it is recommended that greater attention be

paid to the care with the improvement of protective equipment as

an object of study, in the search for alternatives that can minimize

the damage caused by prolonged use for the occupational health

of the area worker.

Erlene Roberta Ribeiro dos Santos

https://orcid.org/0000-0003-3334-3408

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