BackgroundPrevious studies have shown that common headache triggers contribute to the onset of headache attacks on predisposed individuals and are considered important in the prevention of headache. The aim of this study was to compare the different characteristics of triggers among the most common primary headache subtypes (migraine without aura, migraine with aura and tension type headache).MethodsA total of 116 headache patients of the neurology outpatient department of a tertiary hospital in Athens were selected according to the criteria of the International Classification of Headaches—3nd Edition Beta. Patients were interviewed using a questionnaire that contained 35 potential trigger factors.ResultsThe findings showed that migraine and tension-type headache patients report multiple triggers, on a frequent but variable basis. The most frequent triggers reported by all subjects were stressful life events followed by intense emotions. The same applies to both genders, as well as the three headache subgroups. Patients suffering from migraine with aura reported the highest mean number of trigger per person and the highest frequency in almost all the trigger categories. Furthermore, patients with migraine with aura were more likely to report the following triggers: oversleeping, premenstrual period, stressful life events, hot/cold weather, relaxation after stress, menstruation, wind, intense emotions, shining, hunger and bright sunlight. These associations were mostly independent of the sociodemographic characteristics and the presence of anxiety or depressive symptoms.ConclusionThe sensitivity to trigger factors should be considered by both clinicians and headache sufferers.

Background Otolaryngologists are faced with concerning challenges since the onset of the coronavirus disease (COVID-19) pandemic due to significant risk of occupational infection. Transmission can happen during intraoperative exposure to viral particles carried by droplets or aerosols. Endoscopic sinus and skull base surgery are notable for causing aerosolisation, putting healthcare staff at substantial risk. Method We describe the creation of a tight-seal tent from a microscope drape covering the operative field and the operator’s hands with the aim to contain aerosols during transnasal endoscopic surgery. Conclusion The microscope drape technique is a simple barrier measure that could potentially improve safety during endoscopic procedures.

Background Endoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment. Methods The efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3–10 μm in the operating theatre environment. Results Aerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape. Conclusion The method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.

COVIDTrach is a UK multidisciplinary collaborative project that aims to evaluate the outcomes of tracheostomy in COVID-19 patients. It also examines the implementation of national guidance in COVID-19 tracheostomies and the incidence of COVID-19 infections amongst those health care workers involved in the procedure. An invitation to participate in an online survey tool (REDCap) was disseminated to all UK NHS departments involved in tracheostomy in mechanically ventilated COVID-19 patients via the Federation of Surgical Specialty Associations, it's subsidiary organisations and the Intensive Care Society. To date 78 hospitals have submitted 564 COVID-19 tracheostomy cases. Fifty-two percent (n=219/465) of patients who had undergone tracheostomy and were still alive, had been successfully weaned from mechanical ventilation at the point of completing the survey. The all cause in-hospital mortality following tracheostomy was 12% (n=62/530), with 3% of these (n=2/62) due to tracheostomy related complications and the remaining deaths due to COVID-19 related complications. Amongst 400 cases submitting data two weeks after the tracheostomy, no instance of COVID-19 infection amongst operators was recorded. FFP3 masks or Powered Air Purifying Respirators were used by operators in 100% of tracheostomies and a face visor or hood with face shield was available in 99% of cases. This interim report highlights early outcomes following tracheostomy in mechanically ventilated COVID-19 patients. Future reporting from COVIDTrach will include more detailed analysis at later timepoints using comparator groups in order to provide a more comprehensive assessment of tracheostomy in COVID-19.