Headaches from face masks? What do recent studies say?

The fact that wearing face masks can effectively prevent getting infected with the coronavirus, is now adequately proven. Covid face masks therefore belong to the repertoire of measures we are adopting, for logical reasons, to contain the COVID-19 pandemic. The question of whether wearing a mask can also have health drawbacks has been passionately discussed since the beginning of the global pandemic, which has now been going on for years. This article focuses on headaches and discusses the current state of research on the extent to which wearing protective masks can cause headaches.

Clinics and care facilities as settings for scientific enquiries

Even though the requirement to wear masks has now been lifted in many areas of life, it is still not possible for all people to live their daily life without masks. Several professional groups can only carry their work out safely if they are constantly wearing a Covid face mask – which they sometimes do for many hours per day and while strongly physically exerting themselves. To find out what the effects of mask wearing are on the development or worsening of headache disorders, many recent studies have focused on the settings of clinics and care facilities. In related professional groups (medical staff including nursing), wearing a face mask was already unavoidable in many situations before the global COVID-19 pandemic. The increased risk posed to medical staff as well as to patients or people in care since the emergence of the virus means that the daily “wearing times” have greatly increased. This circumstance makes the aforementioned situations particularly fruitful for studies on the effects of mask wearing on headache occurrences.

Reduced performance for all participants

As a general side effect of wearing a protective mask, we must first mention the decline in physical performance. This is also the case for completely healthy people who are working in hospital nursing services or care homes. The extent of the negative impacts and how they come about has now been investigated by a study at the Leipzig University Clinic. The participants either wore no mask, a light surgical mask, or the “FFP2”-certified version. All of them underwent tests in a randomly chosen order, in which different cardiovascular, respiratory, and metabolic functions were measured.

This showed that so-called cardiopulmonary performance (i.e., affecting the cardiovascular system and respiration) was significantly reduced by wearing a mask, regardless of the type of mask. Breathing was particularly affected. Respiratory volume was reduced as well as the speed of breathing in and out. Further surveys reached the conclusion that people wearing masks could only develop a reduced amount of strength. Moreover, the participants stated that they felt their wellbeing was negatively impacted. Thus, the authors of the study view the reduction in performance through permanent mask wearing, as outlined by many professionals, as being scientifically substantiated.

Headaches from masks

The reduced supply of oxygen may well also be the main reason for a further phenomenon that occurs for many people who are professionally required to wear a mask frequently or even constantly: headaches. As one of the main consumers of oxygen, our brain is very sensitive to a reduced supply. This explains why many nursing staff are suffering more from headaches due to difficulty breathing. Wearing a mask also disrupts gas exchange; too much carbon dioxide, which should in fact be exhaled, remains in the body or builds up under the mask. The following breath now brings in what you should in fact be avoiding: “bad” air, i.e., air which contains too little oxygen. In this way, oxygen levels in the blood can be 20% lower than when you breathe freely. If this persists, your brain will increasingly respond with headaches, difficulty concentrating, or forgetfulness.

Different countries, same findings

Besides the study from Leipzig, there are a string of further studies with comparable results. For example, the review paper of an Austrian team summarises several important findings. It shows points of consensus regarding the impact of mask usage on people working in nursing. One Italian study showed that every fourth employee with no previous headache symptoms started to newly experience headaches during the lockdown when mask wearing was compulsory. For employees with pre-existing headaches, the symptoms worsened by around a third. Overall, there was a clear increase in the number of headache days among all nursing staff. A Portuguese study was also able to demonstrate that, for almost all clinic staff who had previously already suffered from headaches and migraine, the symptoms worsened significantly due to the protective masks. Many employees who had had no symptoms up until this point, reported problems with headaches for the first time.

Further surveys from Singapore, Turkey, and Austria confirm these findings. The Singaporean survey found that more than 80% of the questioned nursing staff had new or worsened headaches, which were associated with wearing protective equipment against Covid. What is interesting here is the observation of the immediacy of the limitations; the symptoms appeared within 60 minutes of putting on the equipment and had disappeared within 30 minutes of taking it off for almost 90% of affected people. The Turkish study focuses specifically on migraine. It describes a worsening of the attack frequency, duration, and pain intensity for almost 60% of affected people due to compulsory mask wearing. The consumption of painkillers increased to the same extent. Clearly, people with migraine suffer particularly severely from worsened symptoms as a result of constant mask wearing in the workplace.

Prevention: what can we do?

This data clearly shows that the connection between wearing Covid face masks and headaches is real. People with headaches, who individually experience a worsening of their symptoms due to wearing a mask, are supported by scientific studies. With the easing of mask wearing requirements in many areas of life, a decrease in these additional strains can also be expected. However, in all likelihood compulsory mask wearing will not end for employees of clinics and care facilities during activities involving contact with patients, for the foreseeable future. Measures to prevent additional strains caused by wearing a mask are particularly important for these people, but appropriate conclusions can also be drawn for other affected people for those areas in which wearing a mask continues to be (or is once again) an effective and reasonable measure. For this, let us return to the scientists from Leipzig and their research. The authors state that we can draw conclusions about working life from their results. People who wear masks during strenuous activities must absolutely take more breaks than has hitherto been common practice in many areas. This time off without a mask, ideally while getting fresh air and taking deliberate, deep breaths, can supply the blood with oxygen again. Moreover, tense muscles can be loosened up through movement exercises and made fit for further use.

Everywhere where we cannot or do not wish to refrain from wearing a mask, this measure should be accompanied by compensatory concepts such as regular “breathing breaks”, in order to reduce the risks. In addition, a further imperative arises from the overall situation around the coronavirus: all of us are obliged to take all precautionary measures seriously so that, beyond the already enormous burden, nursing staff are not impacted even more.