Taking part in a hot chili pepper eating contest might have some unexpected consequences, according to a team of doctors from Bassett Medical Center and the Henry Ford Health System.
The Carolina Reaper, also known as the HP22B, is a cultivar of Capsicum chinense. Image credit: Magnolia677 / CC BY 4.0.
The team’s warning comes after a 34-year-old man with no significant medical history ended up in emergency care with painful episodic headaches after eating a ‘Carolina Reaper,’ one of the hottest chili peppers in the world.
“His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest in New York where he ate one ‘Carolina Reaper’,” Bassett Medical Center’s Dr. Satish Kumar Boddhula and colleagues wrote in their paper, published in the journal BMJ Case Reports.
“He then developed intense neck and occipital head pain that became holocephalic. During the next few days, on at least two occasions and in retrospect he thought probably more often, he experienced brief intense thunderclap headaches lasting seconds.”
“The pain was excruciating and thus he came to the ER.”
“He denied any focal tingling sensation or weakness, slurred speech, or transient loss of vision. Physical examination revealed blood pressure of 134/69 mm Hg and no neurological deficits.”
But a CT scan showed that several arteries in the man’s brain had constricted, prompting the doctors to diagnose him with thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS).
(A) CT angiography showing unexpected luminal narrowing in the left supraclinoid internal carotid artery, M1 segment of bilateral middle cerebral arteries, and P1 segments of bilateral posterior cerebral arteries consistent with vasospasm; (B) CT angiography showing resolution of luminal narrowing after 5 weeks of supportive care. Image credit: Boddhula et al, doi: 10.1136/bcr-2017-224085.
“RCVS is characterized by temporary artery narrowing often accompanied by thunderclap headache,” Dr. Boddhula and co-authors said.
“It doesn’t always have an obvious cause, but can occur as a reaction to certain prescription meds, or after taking illegal drugs.”
“This is the first case to be associated with eating chili peppers, although eating cayenne pepper has been linked to sudden constriction of the coronary artery and heart attacks,” they noted.
The patient’s symptoms improved with supportive care, he had no further thunderclap headaches, and a CT scan 5 weeks later showed that his affected arteries had returned to their normal width.
“Given the development of symptoms immediately after exposure to a known vasoactive substance, it is plausible that our patient had RCVS secondary to the Carolina Reaper,” the doctors said.
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Satish Kumar Boddhula et al. An unusual cause of thunderclap headache after eating the hottest pepper in the world – ‘The Carolina Reaper.’ BMJ Case Reports, published online April 9, 2018; doi: 10.1136/bcr-2017-224085
