Prevalence of headaches in healthcare workers while using personal protective equipment during the COVID-19 pandemic: a systematic review and meta-analysis

Study design

The current meta-analysis study of the prevalence of headache complications caused by PPE use in HCWs, including doctors/dentists, nurses/midwives and other medical staff who were required to use PPE during the COVID-19 pandemic. It has been reported according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guideline.21 The study protocol, of which the present paper is part of its findings, has been registered with CRD42021264874 in the Systematic Review Studies Registration System (PROSPERO).

Data sources and search strategy

From December 2019 to February 2023, all the articles in Scopus, Embase, Web of Science and PubMed databases that investigated the prevalence of complications of using PPE in HCWs were retrieved. The searches were conducted on different platforms, including ELSEVIER for EMBASE and SCOPUS, Clarivate for Web of Science and the National Library of Medicine for PubMed.

In addition, Google Scholar was used as a resource for the retrieval of grey literature and additional articles. The keywords were consistent across all primary databases and Google Scholar. These keywords included “complication, side effects, adverse effects, adverse reactions, complaints, headaches, personal protective equipment, PPE, mask, healthcare worker*, healthcare personnel, staff, nursing staff, doctor, physician, nurse*, midwife*, healthcare professional and COVID-19”. The search was conducted using AND and OR operators in the articles’ titles, abstracts and keywords. To enhance the sensitivity of the search, restrictions were kept to a minimum. The complete strategy for searching in the main databases is given in online supplemental appendix 1.

Supplemental material

For example, the search strategy in Embase was as follows:

’side effect’:ti,ab,kw OR ‘physical health’:ti,ab,kw OR physiologic:ti,ab,kw OR complication:ti,ab,kw OR ‘dermatological complaints’:ti,ab,kw OR ‘adverse effect’:ti,ab,kw OR ‘adverse reaction’:ti,ab,kw OR ‘adverse event’:ti,ab,kw OR ‘thermal stress’:ti,ab,kw OR ‘thermal discomfort’:ti,ab,kw OR ‘adverse skin reaction’:ti,ab,kw OR ’skin reaction’:ti,ab,kw OR ’skin injury’:ti,ab,kw OR ’skin damage’:ti,ab,kw OR ’skin problem’:ti,ab,kw OR ’skin dryness’:ti,ab,kw OR ’skin lesions’:ti,ab,kw OR ‘dry hands’:ti,ab,kw OR acne:ti,ab,kw OR rosacea:ti,ab,kw OR irrita*:ti,ab,kw OR rash:ti,ab,kw OR headache:ti,ab,kw OR ‘heat stress’:ti,ab,kw OR ‘heat-related illness’:ti,ab,kw OR ‘contact allerg*’:ti,ab,kw OR dermat*:ti,ab,kw OR scratch:ti,ab,kw OR pruritus:ti,ab,kw OR itch*:ti,ab,kw OR ‘mechanical pressure’:ti,ab,kw OR ‘cutaneous lesion*’:ti,ab,kw OR ‘cutaneous manifestation’:ti,ab,kw OR ‘cutaneous allergy’:ti,ab,kw OR indentations:ti,ab,kw OR ’skin tears’:ti,ab,kw OR ’skin breakdown’:ti,ab,kw OR ‘post inflammatory’:ti,ab,kw OR hyperpigmentation:ti,ab,kw OR crusting:ti,ab,kw OR erythema:ti,ab,kw OR ‘device-related pressure ulcers’:ti,ab,kw OR ulceration:ti,ab,kw OR edema:ti,ab,kw OR deformations:ti,ab,kw OR redness:ti,ab,kw OR ‘pressure damage’:ti,ab,kw OR ‘pressure injur*’:ti,ab,kw OR ‘pressure related*’:ti,ab,kw OR ‘liner pressure ulcers’:ti,ab,kw OR sweat:ti,ab,kw OR perspiration:ti,ab,kw OR ‘intense heat’:ti,ab,kw OR ‘high humidity’:ti,ab,kw OR friction:ti,ab,kw OR occlusion:ti,ab,kw OR ‘hyperhidrosis overheating’:ti,ab,kw OR ‘vision problem*’:ti,ab,kw OR occupational:ti,ab,kw OR hyperemia:ti,ab,kw OR allerg*:ti,ab,kw OR dermatologic*:ti,ab,kw OR atopy:ti,ab,kw OR eczema:ti,ab,kw OR breath*:ti,ab,kw OR burning:ti,ab,kw OR maceration:ti,ab,kw OR wrinkl*:ti,ab,kw OR ‘reduce visibility’:ti,ab,kw OR urticaria*:ti,ab,kw OR ’secondary infections’:ti,ab,kw OR impetigo:ti,ab,kw AND ‘ppe’:ti,ab,kw OR ‘protective equipment’:ti,ab,kw OR ‘protective gear’:ti,ab,kw OR ‘protective suits’:ti,ab,kw OR ‘eye protection’:ti,ab,kw OR ‘eye wear’:ti,ab,kw OR ‘protective visors’:ti,ab,kw OR ‘mask’:ti,ab,kw OR ‘face shield’:ti,ab,kw OR ‘goggles’:ti,ab,kw OR ‘glove*’:ti,ab,kw OR ‘overalls’:ti,ab,kw OR ’shoe cover’:ti,ab,kw OR ‘head cover’:ti,ab,kw OR ‘gown’:ti,ab,kw OR ‘aprons’:ti,ab,kw OR ‘n95’:ti,ab,kw OR ‘filtering facepiece particles’:ti,ab,kw OR ‘ffp2’:ti,ab,kw OR ‘ffp3’:ti,ab,kw OR ‘filtering facepiece respirators’:ti,ab,kw OR ‘ffrs’:ti,ab,kw OR ‘half face mask respirators’:ti,ab,kw OR ‘air purifying respirator’:ti,ab,kw OR ‘half-face elastomeric respirator’:ti,ab,kw OR ‘balaclava’:ti,ab,kw OR ’surgical hood’:ti,ab,kw OR ’surgical cap’:ti,ab,kw AND ‘hcw’:ti,ab,kw OR ‘health care worker*’:ti,ab,kw OR ‘health-care worker*’:ti,ab,kw OR ‘healthcare worker*’:ti,ab,kw OR ‘health care professional*’:ti,ab,kw OR ‘health-care professional*’:ti,ab,kw OR ‘healthcare professional*’:ti,ab,kw OR ‘professional*’:ti,ab,kw OR ‘health care personnel’:ti,ab,kw OR ‘health-care personnel’:ti,ab,kw OR ‘healthcare personnel*’:ti,ab,kw OR ‘health personnel’:ti,ab,kw OR ‘health care staff’:ti,ab,kw OR ‘health-care staff’:ti,ab,kw OR ‘healthcare staff’:ti,ab,kw OR ‘health care provider*’:ti,ab,kw OR ‘health-care provider*’:ti,ab,kw OR ‘healthcare provider*’:ti,ab,kw OR ‘health care employee*’:ti,ab,kw OR ‘health-care employee*’:ti,ab,kw OR ‘healthcare employee*’:ti,ab,kw OR ‘hospital staff’:ti,ab,kw OR ‘nurs*’:ti,ab,kw OR ’staff’:ti,ab,kw OR ‘worker*’:ti,ab,kw OR ‘doctor*’:ti,ab,kw OR ‘clinician*’:ti,ab,kw OR ‘physician*’:ti,ab,kw OR ‘paramedical staff’:ti,ab,kw OR ‘paramedic*’:ti,ab,kw OR ‘practitioner*’:ti,ab,kw OR ’sanitation workers’:ti,ab,kw OR ‘technicians’:ti,ab,kw AND ‘COVID*’:ti,ab,kw OR ‘coronavirus*’:ti,ab,kw OR ’sars-cov-2′:ti,ab,kw OR ’severe acute respiratory syndrome coronavirus 2′:ti,ab,kw OR ‘ncov’:ti,ab,kw OR ’sarscov2′:ti,ab,kw AND (2019:py OR 2020:py OR 2021:py OR 2022:py) AND ‘article’/it AND ([english]/lim OR [persian]/lim)

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