Thunderclap headache caused by the world's hottest chili pepper

A new study, published in the journal BMJ Case Reports, examines the "unusual cause of thunderclap headache" in a man who ate the world's hottest chili pepper — a species aptly named The Carolina Reaper.

Here at Medical News Today, we're a very curious and intrepid bunch. Our team of writers is always looking for new experiences — even when it puts our own health and comfort at risk.

My editor Tim, for instance, has tried everything from cryotherapy to leech therapy — so when he told me he had also eaten the "hottest burger in the world" I was more concerned than I was surprised. "How was it?!" I asked, with trepidation.

Apparently, the burger was so hot that you had to sign a legal waiver before you ordered it. "The chili 'sauce' was actually a black paste," my colleague told me. "I had two bites and had to stop immediately and drink a gallon of milk. My vision went weird, on the edge of hallucination."

"Then, within less than 10 minutes," Tim concluded his story, "I had to go for a very rapid poop." Well, when it comes to the world's hottest burger, I guess the explanation can't get any clearer than this, and due to Tim's vivid details, I doubt many of you who read this will still want to experiment with such a meal.

But if the world's hottest burger makes you hallucinate, what happens when you eat the world's hottest chili pepper?

Unfortunately, nothing good. The newly published study documents an unusual case of thunderclap headache — a severe and often dangerous form of headache — which seemed to be triggered by the consumption of the Carolina Reaper.

The first author of the paper is Dr. Satish Kumar Boddhula, of the Bassett Medical Center, in Cooperstown, NY.

Hot pepper caused arteries to constrict

Dr. Boddhula and colleagues report that a 34-year old otherwise healthy man came into the emergency room with an episode of thunderclap headache after he had eaten one Carolina Reaper in a hot pepper contest.

His symptoms included dry heaves but without vomiting, followed by severe pain in the neck and the region of the brain's occipital lobe.

During the following days, the man continued to experience bouts of thunderclap headaches, which lasted only a few seconds but were excruciatingly painful.

The most common cause of thunderclap headache is subarachnoid hemorrhage, and the best way to diagnose it is with a computed tomography (CT) brain scan.

However, in this case, the CT angiography did not reveal any aneurysms. Instead, the scan found constricted arteries in the patient's brain.

Therefore, the physicians diagnosed the man with "thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS)."

RCVS temporarily causes the arteries to constrict, an effect often followed by thunderclap headaches. As the doctors explain in the paper, many cases of RCVS don't have an obvious cause, but can be a side effect of certain medications or illegal drugs.

Luckily, in this case, the man soon felt better, and the symptoms went away by themselves; after 5 weeks, another CT scan showed perfectly normal arteries.

RCVS may cause thunderclap headaches

This is the first time that eating hot peppers has been linked with RCVS, the authors note, but they do caution that eating cayenne pepper has been previously associated with coronary artery constriction and heart attacks.

Therefore, the authors conclude, "RCVS should be considered in the differential diagnosis in patients who present with thunderclap headache after ingestion of cayenne pepper, which is a vasoactive substance."

"RCVS should be considered as a potential cause of thunderclap headache after most common causes are ruled out including subarachnoid hemorrhage," the doctors add.

Eating the Carolina Reaper, then, makes the near-hallucinatory vision and the "rapid poo" my colleague experienced look like child's play.

That said, I still wouldn't try either of these two experiences, and perhaps neither should you. For those who still find the idea of a hot chili contest tempting, it might be worth weighing the cash prize against the price you'd like to put on your arteries.