| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T194 |
0-10 |
Sentence |
denotes |
Discussion |
| T195 |
11-113 |
Sentence |
denotes |
The current COVID-19 pandemic has caused a substantial change in the workflow of health professionals. |
| T196 |
114-180 |
Sentence |
denotes |
One of the most important characteristics has been the use of PPE. |
| T197 |
181-280 |
Sentence |
denotes |
Masks are a critical preventive measure and are most essential when social distancing is difficult. |
| T198 |
281-532 |
Sentence |
denotes |
It is clear that adherence to universal mask policies reduces the transmission of SARS-CoV-2.14 But, according to the data obtained, we demonstrate a statistically significant association between the use of filter masks and the appearance of headache. |
| T199 |
533-653 |
Sentence |
denotes |
In the physiopathology of a new-onset headache, the exact mechanisms may be multiple, complex and not always well known. |
| T200 |
654-1003 |
Sentence |
denotes |
Peripheral nociceptive structures and central sensitisation mechanisms may be involved in their development.15 16 The current International Headache Classification proposes, generically for secondary headaches, that the diagnostic criteria do not require remission or improvement of the underlying causal disorder before the diagnosis is formalised. |
| T201 |
1004-1303 |
Sentence |
denotes |
For acute processes, a close temporal relationship between the onset of the headache and the onset of the suspected causal disorder is usually sufficient.11 Following this classification, mask-associated headache would probably be a multifactorial disorder with unknown aetiopathogenesis at present. |
| T202 |
1304-1512 |
Sentence |
denotes |
Hypothetically, a number of factors may explain the association with filter mask use, including hypoxia, hypercapnia, local compression and mechanical phenomena, as well as anxiety about wearing the device.10 |
| T203 |
1513-2729 |
Sentence |
denotes |
In the scientific literature there are not many studies that relate the use of face masks to changes in the concentration of oxygen and/or carbon dioxide (CO2), but it seems a plausible hypothesis due to the barrier element that is interposed in the physiological ventilation mechanism.17 In a Taiwanese cohort of 39 patients with end-stage renal disease who wore N95 masks during the 2002 SARS outbreak, the study found a significant reduction in arterial oxygen pressure from baseline and an increase in other respiratory adverse effects.18 Another study conducted in a cohort of 130 astronauts subjected to high CO2 pressures during controlled training showed a significantly higher incidence of headache in the exposed group, in addition to respiratory symptoms and difficulty in concentrating.19 At the University of Wollongong, a study on the effects of CO2 inhalation on workers wearing respiratory protection devices showed that high levels of CO2 were associated with feelings of discomfort and significantly reduced tolerance and time of device use.20 The effect on respiratory physiology and muscle performance of wearing training masks designed to simulate a variable altitude situation has been studied. |
| T204 |
2730-3146 |
Sentence |
denotes |
The results are mixed in terms of objective performance parameters, however, it seems that mask use reduces working speed and negatively influences levels of alertness and task focus.21 In 2014, a pilot study evaluated the consequences on respiratory physiology of surgical mask and N95 face mask use and the extent to which nasal inspiratory and expiratory resistance and discomfort were altered in the individuals. |
| T205 |
3147-3480 |
Sentence |
denotes |
Physiological changes such as increased respiratory resistances were observed after 3 hours of use.22 Headache associated with filter mask use could be included according to ICHD-311 in the section on headaches due to homeostatic disorders where those related to alteration of oxygen and CO2 partial pressure parameters are included. |
| T206 |
3481-3810 |
Sentence |
denotes |
Another phenomenon probably related to the physiopathology of headache after PPE use is the external compression that it generates, as recently reflected by the group of Ong et al.23 In most cases there is a temporal relationship between the use of devices and the headache, as well as the topographical location of the headache. |
| T207 |
3811-4199 |
Sentence |
denotes |
As with homeostatic changes, ICHD-3 typifies a type of headache attributable to uninterrupted compression or traction of pericranial soft tissues.11 Pressure or tractional forces from the mask, together with the accompanying straps, may lead to local tissue damage and exert an irritative effect on the underlying superficial sensory nerves innervating the face, head and cervical region. |
| T208 |
4200-4295 |
Sentence |
denotes |
There are several examples in the literature that would be consistent with this mechanism.10–24 |
| T209 |
4296-4362 |
Sentence |
denotes |
The last factor to be mentioned is the level of anxiety or stress. |
| T210 |
4363-4620 |
Sentence |
denotes |
Multiple ways of relating stress and headache have been described, either as ‘de novo’ or as exacerbation in an individual with primary headache.25 In the case of the SARS-CoV-2 pandemic, healthcare workers may be affected by critical incident stress (CIS). |
| T211 |
4621-4788 |
Sentence |
denotes |
Critical incidents are events in which people witness or experience tragedy, death, serious injury or threatening situations, which can have a strong emotional impact. |
| T212 |
4789-5006 |
Sentence |
denotes |
The signs and symptoms of CIS can be physical, cognitive, emotional and behavioural.26 In our work, we observed that the level of stress in subjects with headache is significantly worse in all aspects measured by PPQ. |
| T213 |
5007-5135 |
Sentence |
denotes |
We also showed that the risk of developing headache is higher among nurses and other health professionals than among physicians. |
| T214 |
5136-5221 |
Sentence |
denotes |
The explanation for this result is complex, but there are three plausible hypotheses. |
| T215 |
5222-5625 |
Sentence |
denotes |
As a general rule, doctors live with a higher level of stress in the course of their work, and therefore, situations considered conflicting do not increase their usual stress threshold excessively.27 It could also be explained by the use of negative coping strategies in some professional groups as opposed to others28; these strategies, not measured in our work, would be related to professional level. |
| T216 |
5626-6009 |
Sentence |
denotes |
The third potential explanation, in line with some published studies, is that the higher risk of headache among nurses and other health professionals than in the medical group, is due to the differential characteristics of the workers' occupation, which would involve the use of other devices, cleaning materials, activities with greater energy expenditure or changing work shifts.29 |
| T217 |
6010-6199 |
Sentence |
denotes |
Different factors or comorbidities that may influence the development of headache have been described in the literature.30 If we look at risk markers, age and sex deserve special attention. |
| T218 |
6200-7024 |
Sentence |
denotes |
The female sex is closely related to the development of ‘de novo’ headache.31 Age is a determining factor in the classification of headache according to the International Headache Society.11 Several studies have shown that pain intensity,32 the degree of headache disability and the possibility of secondary headache occurrence are age-related factors.33 In terms of other individually modifiable risk factors, the relationship between blood pressure changes and primary headache should be highlighted, as they share mechanisms of action such as vascular endothelial dysfunction or poor cardiovascular autonomic regulation.34 However, in our study we did not find a clear association between different comorbidities of the individual and the appearance of headache, except for tobacco consumption in the univariate analysis. |
| T219 |
7025-7138 |
Sentence |
denotes |
In a review of the relationship between smoking and the occurrence of headache, controversial data were obtained. |
| T220 |
7139-7283 |
Sentence |
denotes |
The studies are mostly retrospective and limited, and there is no definite evidence that tobacco is an independent cause of headache occurrence. |
| T221 |
7284-7484 |
Sentence |
denotes |
However, most patients with migraine define it as a trigger.35 Headache is one of the most pronounced symptoms in patients suffering from asthma, a fact that has been described in a few papers so far. |
| T222 |
7485-7671 |
Sentence |
denotes |
In a study of 93 patients, a statistically significant difference was found in this area, as 62.4% of asthmatics had headache, whereas in the control group the percentage was only 32.8%. |
| T223 |
7672-8103 |
Sentence |
denotes |
Other factors such as the use of steroid inhalers, the presence of rhinitis, conjunctivitis or respiratory parameters, such as forced expiratory volume in one second, were studied and characterised.36 In our study, being asthmatic would act as a protective factor against headache associated with mask use, perhaps because of a greater tolerance to hypoxia, and therefore a higher threshold for developing headache for this reason. |
| T224 |
8104-8205 |
Sentence |
denotes |
It is especially important to discuss possible methods to reduce the impact of PPE-induced headaches. |
| T225 |
8206-8668 |
Sentence |
denotes |
Our findings are in agreement with multiple studies showing that headache triggers are often associated with a change in homeostasis, underscoring the importance of addressing these factors to optimise headache control.37 For example, encouraging the use of powered air-purifying respirators (PAPRs) is a method for healthcare workers working in high-risk areas and for long periods, since the PAPR provides additional safety and reduces the accumulation of CO2. |
| T226 |
8669-8883 |
Sentence |
denotes |
On the other hand, we recognise that the conventional N95 face mask fit considers only the overall fit factor and does not take into account the level of tolerability, especially when worn for long periods of time. |
| T227 |
8884-9275 |
Sentence |
denotes |
Since current mask designs can cause headaches and affect compliance, the administrators should think about devising new work schedules for healthcare workers (like shorter working hours) and for people who need to wear a filter mask.38 Through novel engineering solutions, next-generation face masks need to be better designed with priority on tolerability and less predisposed to headache. |
