It can be scary to think about, but the hard truth is that the COVID-19 pandemic isn’t going anywhere for a long time. That means you’re going to have to become good friends with your mask, even if you’re vaccinated and boosted.
Wearing a mask every time you go somewhere indoors in public isn’t just an official CDC guideline (and in some places, a legal requirement)—it’s also one of the easiest things you can do to keep yourself and others safe during this time. Of course, what’s easy for most people is often a lot more complicated for migraine sufferers.
We’ve been hearing from a lot of you that you’re worried that wearing a mask every day will make your migraine worse. So we spoke to migraine expert and Cove Medical Advisor Dr. Philip Bain to get the truth about whether masks trigger attacks, plus some tips for migraine-safe mask-wearing.
How can wearing a mask trigger migraine attacks?
If you’ve been staying indoors all this time, you might be a bit confused about what masks have to do with migraine. After all, wearing a mask won’t change the weather, your diet, your sleep schedule, or plenty of other major migraine triggers.
That’s true, but prolonged mask-wearing can change your habits in ways that make attacks more likely. For example, if you normally drink coffee every day during your commute to work, wearing a mask would make that impossible—and increase the likelihood of getting a headache from missing out on your usual caffeine boost. For non-coffee-drinkers, the big concern here is that you’ll drink less water if your mouth is covered for much of the day.
It’s an established fact that dehydration can cause migraine attacks, but people are also reporting potential triggers associated with mask-wearing that haven’t been thoroughly studied yet. Given the fact that most people haven’t had to wear a mask every day until now, it makes sense that this situation might bring to light previously unknown triggers. Members of the Cove community have pointed to breathing difficulties, overheating, and pressure around the ears (from the elastic or straps that hold the mask in place) as possible triggers, though it’s too soon to tell if any of them will hold true for the majority of migraine sufferers.
Is there any proof that masks cause migraine attacks?
Unsurprisingly, there hasn’t been much research yet into the relationship between mask-wearing and migraine. But there have been a few studies of typical headaches focusing on people who’ve had to wear masks to work since long before COVID-19: medical workers.
A 2006 study of 212 healthcare workers required to wear the medical-grade N95 face mask found that 37% said the mask gave them headaches, and 32% of those people had headaches more than six times a month. In a newer study at the National University Hospital in Singapore, 81% of medical personnel who wore the N95 mask for 6 hours a day developed headaches. 23% of participants said their headaches included migraine symptoms like nausea and photophobia.
In January 2022, the first study on the impact of mask wearing (and disinfectant use) on actual migraine sufferers during COVID-19 was published in the Journal of Clinical Neuroscience. The study looked at 310 patients in Turkey with varying degrees of migraine severity and found that 57.1% of them had experienced a worsening of their condition during the pandemic. (Interestingly, 11.9% of participants actually improved after the onset of COVID-19, likely because staying home more meant getting exposed to fewer triggers.) Overall, the study found that "migraine worsening was associated with wearing a mask for a long time and using [masks that put pressure on the scalp] and double masks."
So, the existing medical research, while not exactly overwhelming, does support the idea that mask-wearing can cause both regular headaches and migraine attacks. That said, it’s important to note that the participants in these studies were wearing masks for several hours a day, which might not apply to you if you work from home or don’t need to wear a mask at work.
Is it safe to wear a mask every day?
While wearing a mask for long periods of time might actually worsen headaches, you’ve probably heard some other claims about the dangers of mask-wearing that are a bit less well-founded. Most worrying is the suggestion that wearing a mask causes hypercapnia, a condition caused by having too much carbon dioxide in the blood. Symptoms of mild hypercapnia include dizziness, fatigue, headaches, and shortness of breath. In severe cases, it can cause muscle twitching, passing out, seizures, and even coma.
So is there any merit to the idea that wearing a mask causes hypercapnia, or any other serious health risks? When we put that question to Dr. Bain, his reply was straightforward: “No.” A CDC representative quoted by Reuters gave more context: “The level of CO2 likely to build up in the mask is mostly tolerable to people exposed to it. You might get a headache but you most likely [would] not suffer the symptoms observed at much higher levels of CO2...It is unlikely that wearing a mask will cause hypercapnia.”
How can I avoid migraine triggers while wearing a mask?
We hope you’re relieved to hear that wearing a mask likely won’t cause any serious health complications, but we get that you might still be worried about the “it triggers migraine attacks” part. So here are our best tips for keeping migraine under control while staying safe.
Set a few phone alarms
This is a simple solution for a big problem. Many migraine sufferers don’t need to be reminded that dehydration can trigger attacks, but now that your mouth is covered for much of the time, you might need to be reminded to actually drink water. Setting a few alarms on your phone throughout the day is an easy way to remind yourself to stay hydrated. If you’re a coffee or tea drinker, you can also use alarms to make sure you don’t forget to get your daily caffeine fix.
If loud sounds from your phone are another potential trigger for you, try a low-tech alternative like putting a Post-it note that says “Drink water!” somewhere you’ll see it often.
Try a less irritating mask
Think the pressure on your ears from your mask is what’s giving you headaches? Luckily, there are plenty of ways to take the pressure off of your ears and keep your mask in place by other means. Paperclips, headbands, and plastic or fabric connectors made specifically for masks can all secure your mask behind your head without letting it touch your ears. For more suggestions, check out this helpful roundup of tips from nurses.
If a simple adjustment just won’t cut it, you can look into different kinds of masks. The CDC now recommends that "you wear the most protective mask you can, that fits well and that you will wear consistently."
That could mean putting on a KN95 mask when you're around a large number of people you don't know, like while taking public transit, but wearing a more comfortable surgical mask in less risky situations. If you have more questions about which masks to use when, talk to your doctor.
Manage your stress
If you’ve only been wearing your mask for short bursts but still feel like your headaches are getting worse, the problem might be pandemic stress rather than the mask itself. Tracking your migraine and your mask-wearing could help you figure out what’s triggering your attacks. If that’s not enough, “Wear the mask in a safe, comfortable place for a while, such as in your home,” Dr Bain suggests. “If your migraine doesn’t get worse, then it’s more likely related to the stress and anxiety of going out rather than the mask.”
If living through a global pandemic has increased your anxiety, you’re certainly not alone. These are difficult times, and that’s bound to have an effect on your mental health. Make time for self-care by incorporating stress-relieving activities like exercise, yoga, and meditation into your new routine. Just getting outside for a brief daily walk (at an appropriate distance from others, of course) is a great place to start. You can find more tips for reducing anxiety in our guide to stress management for migraine sufferers.
We don’t want to give you the impression that you need to manage all of your stress by yourself. It’s easy to feel disconnected these days, which makes leaning on your friends, family, and community (virtually!) more important than ever. If you don’t have anyone in your life who understands what you’re going through, try joining an online migraine community. Many mental health providers are transitioning to virtual visits, so don’t hesitate to seek professional help if you need it.
While we’ll need more research to fully understand the relationship between mask-wearing and migraine, it’s not too soon to say that pandemic life exposes migraine sufferers to plenty of new triggers. Tracking your attacks carefully will help you see what’s affecting you, but some triggers, like stress, are nearly impossible to avoid.
Keep migraine medication on hand to make sure you’re always prepared for an attack. With Cove, you can get prescription and over-the-counter medication and treatment delivered directly to your door—no in-person appointments or pharmacy pick-ups required. Connect with a doctor who specializes in migraine today.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Photo by Bára Buri on Unsplash