This week’s edition of BMJ Case Reports reads more like a Darwin Awards near-miss thanks to the inclusion of a case treated by New York state physicians.
The unique medical event was discovered when a 34-year-old man came into an emergency room and shared with staff that he had been experiencing repeated flashes of extremely painful, quick-onset headaches, called thunderclap headaches, for the past few days. The instigating event? It all began after he consumed a Carolina Reaper at a hot chili pepper-eating competition.
Specifically bred for heat, the Carolina Reaper is the hottest chili in the world. On the Scoville heat unit (SHU) scale of capsaicin concentration – where just one drop of oil from the chili can be detected in the SHU number of drops of water – Carolina Reapers’ average measurement is 1.6 million SHU; in comparison, the already potent habanero is rated at only 100,000 to 350,000 SHU.
Immediately following ingestion, the patient began dry heaving (but did not throw up) and developed excruciating neck and head pain that progressed into the thunderclap headaches.
Though he displayed no neurological impairment, physicians needed to rule out a life-threatening brain bleed caused by an aneurysm, torn artery, or migrated clot – so they performed a CT scan.
The imaging showed that several arteries in his brain were abnormally constricted, leading to a diagnosis of reversible cerebral vasoconstriction syndrome (RCVS). According to the report’s authors, RCVS develops as an adverse response to certain prescription drugs, such as antidepressants and migraine medication, or illicit substances such as cocaine, amphetamines, and ecstasy. The patient's arteries typically return to normal a few days to weeks after they are no longer exposed to the causative drug – or in this case, spicy fruit.
“Our patient’s symptoms improved with supportive care, he had no further thunderclap headaches, and repeat CT angiography five weeks later demonstrated resolution of [arterial constriction] consistent with RCVS,” wrote the physicians.
After studying the medical literature, the team concluded that no other cases of chili pepper-induced RCVS have been recorded. In 2012, however, physicians in Turkey treated a 25-year-old man who had a heart attack after one of the arteries in his heart constricted dramatically. The cause turned out to be cayenne pepper powder pills that the patient was taking for weight loss.
In sum, don’t underestimate capsaicin, no matter how much you love hot sauce. Plants evolved the ability to produce the capsaicin in order to defend against mammals trying to eat their seeds. When viewed in that context, it’s not surprising that a chemical weapon would cause splitting headaches.
