Some like it hot, but for a 34-year-old man, one hot pepper was a tad too hot.
In fact, it sent him to the emergency room.
Doctors described the strange and cautionary case of excruciating headaches in a man who gobbled down a “Carolina Reaper” during a hot pepper eating contest. For perspective, it's been labeled the hottest pepper by the Guinness World Records.
The man’s first symptoms were dry heaves that started immediately after he downed the pepper, according to the article published in BMJ Case Reports.
Then came severe neck pain and then, stunningly painful headaches. They were of a type that has been dubbed “thunderclap headaches,” which are usually associated with serious conditions like clots, bleeding or a torn blood vessel in the brain, said study co-author Dr. Kulothungan Gunasekaran, who was at the Bassett Medical Center in Cooperstown, New York, when the study was done and is now a senior staff physician at Henry Ford Hospital in Detroit.
Though the headaches didn’t last long, they kept coming. That sent the frightened man to the emergency room.
Gunasekaran and his colleagues first ruled out the dangerous potential conditions through lab tests and brain scans. When they looked closely at the CT scan of the man’s brain, they saw the cause of his pain: Their diagnosis was that high levels of capsaicin in the pepper had affected the blood vessels in the man's brain. In their report, the doctors suggested the most likely cause of the headaches was a condition called "reversible cerebral vasoconstriction syndrome," which is characterized by narrowed blood vessels.
There are reports of people having similar issues when using capsaicin pills and patches for pain relief.
The good news, Gunasekaran said, was that “the sudden constriction of the blood vessels to the brain is reversible.” Sure enough, with supportive care including hydration and pain medications, the man pulled through and eventually the headaches subsided.
Gunasekaran suspects this kind of side effect might occur with any of the super-hot peppers. “But I cannot really say all hot peppers would cause it,” he said. “There is not a lot of research in this field.”
Most likely he said, some people are more susceptible than others.
Dr. Zhaoping Li wasn’t at all surprised by the man’s predicament. She has studied capsaicin as a weight-loss aid. “It’s almost the same as a stimulant,” she explained. “At lower doses, it can get the heart rate and the blood pressure up and it can constrict blood vessels.”
“In large amounts, there’s a concern, particularly for people with heart disease and other medical conditions,” said Li, who is director for the Center for Human Nutrition at the University of California, Los Angeles.
In fact, there have been reports in the medical literature of non-fatal heart attacks in people taking capsaicin to lose weight.
Those most at risk for side effects are people who don’t have much experience with capsaicin, Li said. The best way to avoid side effects is to build up a tolerance to spicy foods, she added.
“You do mild for a month then go to medium and then you can go to the extreme,” Li said. “Even then, not everyone can adapt.”
Li also warns against mixing capsaicin with alcohol. If you do, “the brain may not be sharp enough to tell if the blood pressure has gone up or if you’re getting into trouble,” she explained.
Ultimately, Gunasekaran said, anyone who “develops these symptoms should seek out medical care.”