Beware The Heat

"The patient ate the pepper and immediately starting having a severe headache that started in the back of the head and spread all over within two seconds."
"Because he could not tolerate the headache, they sent him to the ER."
"Then CT angiography was done, which showed narrowing of the blood vessels in the brain. You could see the beaded appearance [of the arteries], and the yellow arrows point to the narrowing of the blood vessels." 
"This is the first time that pepper has been related to RCVS. Capsaicin, the key ingredient in the pepper, is a vasoactive substance, so it could potentially narrow the blood vessels to the most important organs like the heart and brain."
"The patient was followed up after five weeks, and a repeat CT angiography showed resolution of the narrowing of the blood vessels. Usually, RCVS resolves on its own after days to weeks."
Dr. Kulothungan Gunasekaran, internal medicine physician, Henry Ford Hospital, Detroit 

"On a one to ten scale, it's off the charts [with symptoms so severe they emulate the kind of stroke that results from bleeding in the brain]."
"[If you're hit with a headache of that intensity it calls for medical attention] whether you've bitten into a pepper or not."
Dr. Lawrence C. Newman, neurologist, director headache division NYI Langone Health

The Carolina Reaper is again officially the Worlds Hottest Pepper as ranked by Guinness Records.

"People who eat whole Reapers are just being stupid [but] we eat them all the time [with few consequences -- beyond pain]." 
"I knew beforehand [when responding to the Death Nut Challenge of eating viciously hot peanuts], I shouldn't do it. I was in pain for two hours."
"Citric acid seems to work the best to alleviate the pain. Don't chug milk because you'll just throw it up."
Ed Currie, PuckerButt Pepper Co., Fort Mill, South Carolina

In this Dec. 12, 2013 photo, Ed Currie holds three Carolina Reaper peppers

As wackily eccentric as Mr. Currie sounds he knows whereof he speaks since he was the person who developed the hot, really hot, raging hot, Reaper pepper properly called the Carolina Reaper, considered the hottest pepper in the world, which should be handled with care given its reputation. Perhaps news of its reputation hadn't penetrated the consciousness of an unnamed 34-year-old who thought it would be a fun challenge to eat some, while taking part in a hot-pepper-eating competition.

People do end up doing the darnedest things for a laugh. But this man wasn't laughing, at least not when after consuming the pepper he began a series of dry heaves; uncomfortable and disconcerting to be sure, but nothing whatever in comparison to the severity of the headache that then gripped him. A headache that clinicians call a thunderclap headache. Sometimes 'fun' impulses don't turn out too well, that fellow now knows.

He ended up at Bassett Medical Center in Cooperstown, presenting with that excruciating pain in his head and neck that had developed like a bolt of thunder out of a clear-blue sky. With some remarkable suffering in consequence, no doubt accompanied by rude commentary, the worst of the headache seemed to fade. But his experience hadn't concluded since in the following few days that thunderclap hit him again and again, which convinced him to seek medical attention.

Tests were indicated, and head and neck scans revealed constriction normally associated with arteries, causing intense headaches. While this was a learning experience for the unfortunate hot pepper competitor it also proved a study opportunity for the consulting doctors and they reported that experience in BMJ Case Reports, with Dr. Gunasekaran one of the authors.

It was pointed out that this guy's experience was somewhat out of the ordinary for a popular pepper that many people enjoy, experiencing no untoward consequences, apart from the initial mouth-puckering pain. This is a pepper whose searing heat effect is legendary, measuring at over two million Scoville heat units, in comparison to a really hot habanero that might come in on the heat scale at 500,000 Scoville units.

The study that resulted from this man's experience who did surmount his few weeks of pain and is now normal, suggests that capsaicin which is coincidentally being studied for its role in alleviating pain and lowering blood pressure, can also have unexpected effects on some people particularly sensitive to it. Medical reports of two nonfatal heart attacks in young men resulting from spasms in arteries were associated with cayenne pepper pills and a capsaicin patch sold in China and Turkey.

Mr. Currie, the proprietor of PuckerButt Pepper Co., and the creator of the Reaper, advises that the average person avoid using any but small amounts of any really hot pepper in food preparation. He is himself obviously not the average hot pepper consumer, enjoying testing the heat of various types of peppers. Some people test themselves through strength trials of lifting and throwing, he lifts the peppers to his mouth and trusts he won't throw up.

The man whose experience was detailed in the report was eventually diagnosed with reversible cerebral vasoconstriction syndrome, or RCVS, undoubtedly caused by the hot peppers. RCVS is characterized typically by an intense "thunderclap" headache resulting from constriction of blood vessels in the brain, generally resolving on its own within a few days or weeks.

Normally RCVS is linked to some types of medication like ergotamine or triptans and illicit drugs like cocaine and amphetamines, and not hot peppers. In some instances really severe cases can turn out to be life-threatening, explains Dr. Anne Ducros, professor of neurology, head of the migraine and headache unit at the University of Montpellier.

"A proportion of patients will have a severe form with strokes, and they can get either an intracranial hemorrhage or an ischemic stroke. But the mortality is low, around 2% ... and most patients who die from RCVS are young women and often in the postpartum state. Most of them will do well with only recurrent headaches, and then they have a total recovery", she explained.