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Sick burn: world's hottest chili pepper sends man to hospital with 'thunderclap' headache

The Carolina Reaper
The Carolina Reaper is currently the hottest chili pepper in the world, according to the Guinness Book of Records.

I’ve never understood why anybody enters an eating contest. Not only do such competitions seem blatantly gluttonous, but they also pose very real health risks, including gastric ruptures, seizures and choking to death.

But, hey, that's just me.

My feelings about such eating contests got reinforced earlier this week, however, when I read in BMJ Case Reports about a 34-year-old man who developed a “thunderclap” headache after participating in a hot-pepper-eating competition in central New York.

The man had eaten a Carolina Reaper, which is currently the hottest chili pepper in the world, according to the Guinness Book of Records. The pepper scores an average of 1,641,183 Scoville Heat Units (SHU), which is a measurement of capsaicinoids, the natural chemical compounds that give chili peppers their spicy heat.

By comparison, jalapenos tend to score between 3,000 and 8,000 SHUs.

After eating the Carolina Reaper, the man started dry heaving. That uncomfortable symptom was soon followed by intense pain in his neck and in the lower back area of his skull. The pain then settled into a diffuse but still-debilitating headache, which continued for several days.

During that time, the man experienced at least two, but perhaps more (he told doctors, he couldn’t remember exactly how many), “thunderclap” headaches. These are excruciatingly painful headaches that come on suddenly, like a clap of thunder. Fortunately, they are very brief, usually lasting no more than a minute. But they can be signs of something serious, including a life-threatening aneurysm in the blood vessels of the brain. 

The severity of the thunderclap episodes sent the pepper-eating contestant to the emergency department of the Basset Medical Center in Cooperstown, New York.  A computed tomography (CT) scan revealed no aneurysm or obvious neurological defects, but doctors did find constricted blood vessels in his brain.

The doctors diagnosed the man with “thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS)” — in other words with a headache caused by constricted blood vessels in the brain.

As its name implies, RCVS is reversible, and that is what happened to the Carolina Reaper victim. “Our patient’s symptoms improved with supportive care,” the doctors write, “[and] he had no further thunderclaps headaches.” 

A second CT done five weeks later showed no more narrowing of the man’s blood vessels.

The authors believe this is the first case in medical literature of a thunderclap headache being linked to eating chili peppers, although they note a case reported in 2012 of a 25-year-old man who experienced a sudden constriction of the coronary artery and a heart attack after taking a dietary supplement — cayenne pepper pills — to lose weight.  

The take-away message from both these cases is not to avoid spicy food. (Dietary supplements, however, are another thing. Independent research has repeatedly shown they offer no benefit to most healthy people and can often be harmful.)

The message is more about avoiding extremes with the foods you consume.

The Carolina Reaper report is also an important reminder to take intense headaches seriously. In this case, the thunderclap headache turned out to have a non-life-threatening cause, but such headaches can also be a medical emergency.

As the Mayo Clinic advises, “Seek immediate medical attention for any headache that comes on suddenly and severely.”

For more information: You can read the case study in full on the website for BMJ Case Reports.

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