Wearing full PPE for four hours or more could result in a headache, suggests research published in Headache. Researchers in Wuhan, China, surveyed 158 healthcare workers during February and March 2020, which was the Covid-19 peak for the area. They found that 81% of frontline healthcare workers developed new-onset headaches due to wearing PPE—N95 facemask and protective eyewear—for long hours. This combined exposure to N95 face masks and protective eyewear worn for more than four hours per day predisposed healthcare workers to develop headaches. In addition, any head pain or discomfort was found to correspond anatomically to the areas of compression by either the mask or goggles and their straps.

For the 30% of the responders who had a history of migraine or tension-type headaches, their headaches worsened. Specifically, the increased PPE usage had affected the control of their background headaches, affecting their work performance. Comments regarding this study point out that sleep problems and psychological distress could cause the reported headaches in this study, and the researchers agree. However, they responded that the prevalence, 81%, “of de‐novo headaches reported by our PPE-donning healthcare workers outweighs the considerably lower prevalence of sleep problems and psychological distress.”

This isn’t the only research to come to this conclusion. Another study in the Journal of Critical Care reported similar findings from a web-based survey distributed in April 2020. From the 2,711 responses that researchers received from healthcare workers worldwide, they discovered that the average wear time of PPE was four hours. And like the Wuhan healthcare workers, these respondents reported headaches (28%) and pressure areas (44%), as well as heat (51%), thirst (47%), inability to use the bathroom (27%), and extreme exhaustion (20%).

“Given that the current pandemic may last for a longer period of time, better strategies targeted at optimizing work-rest cycles, thereby limiting the duration of PPE exposure, could be considered,” Dr. Jonathan Ong, the lead author of the Wuhan study, told BioSpectrum Asia. “In the longer term, we need to improve the design of personal protective equipment so that they are better tolerated and more comfortable to don when used for a more prolonged duration.”