Carolina Reaper hot pepper

Those of us who love hot peppers cherish the experience of pain and pleasure brought on by the chemical called capsaicin. That is the active ingredient in hot chili peppers that lights up our taste buds, makes us sweat and brings tears to our eyes. Craving for hot sauce has taken off over the last couple of decades. Salsa sales have skyrocketed. There are now products like Crazy Jerry’s Brain Damage, Mad Dog Inferno, and Blair’s Mega Death Sauce. Each one seems to try to outdo the others for hotness. One hot pepper, the “Carolina Reaper,” is considered the hottest chili pepper in the world. It did some serious damage to one taster.

The Hot Pepper Contest:

Some vegetables need to be treated with kid gloves. That’s the conclusion from the medical journal BMJ Case Reports, April 9, 2018. In this description, we learn about a 34-year-old healthy man who ended up in the emergency room after developing a severe headache.

He had been participating in a hot pepper contest. The doctors who saw him in the ER related the following story:

“His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest where he ate one ‘Carolina Reaper,’ the hottest chili pepper in the world. He then developed intense neck and occipital head pain that became holocephalic. During the next few days, on at least two occasions and in retrospect he thought probably more often, he experienced brief intense thunderclap headaches lasting seconds. The pain was excruciating and thus he came to the ER.”

What is Occipital Head Pain?

The medical definition for this kind of headache goes something like this: It is major pain behind the eyes, in the back of the head and up the neck. It is thought the pain follows the occipital nerves that run from the top of the spinal cord to the scalp area behind the head. This kind of headache can be brought on by an accident that causes injury to the head and/or neck. Words used to describe the pain include

  • “Stabbing”
  • “Piercing”
  • “Excruciating”
  • “Jabbing”
  • “Burning”

What Happened After the Hot Pepper Tasting?

The doctors performed a CT scan and a complete neurological workup. They were concerned that he might have had a brain bleed (subarachnoid hemorrhage). Other possibilities could have been a blood clot in a vein in the brain or an artery breaking apart (artery dissection). Needless to say, the ER doctors were worried.

Once the physicians ruled out a stroke or other life-threatening crisis, they considered other possibilities. They made a presumptive diagnosis of “thunderclap headaches” brought on by severe constriction of brain arteries. The medical term is reversible cerebral vasoconstriction syndrome (RCVS).

What Else Causes RCVS?

Once a stroke or other life-threatening source has been ruled out, emergency physicians start looking for other contributing factors. Because a thunderclap headache is often triggered by constriction of brain arteries, they need to determine what else could cause this sort of arterial spasm?

Drugs can sometimes be the culprit. Migraine medicines such as ergotamine or triptans can do it. So can some antidepressants (SSRIs like fluoxetine or sertraline). Decongestants have also been linked to RCVS. And other vasoconstrictors like amphetamine and cocaine may trigger a thunderclap headache.

The Carolina Reaper and Hot Pepper Headache:

The authors of the BMJ Case Reports article discovered that their patient had severe narrowing in four brain arteries. Over the next several weeks the arteries gradually returned to normal. As they dug into the medical literature they discovered one case where cayenne pepper pills were linked to constriction of coronary arteries and a heart attack (International Journal of Emergency Medicine, January 20, 2012).

The ER Physicians’ Conclusion:

“Given the development of symptoms immediately after exposure to a known vasoactive substance, it is plausible that our patient had RCVS secondary to the ‘Carolina Reaper.’ Treatment is observation and removal of the offending agent.”

People’s Pharmacy Perspective:

This one case report is hardly definitive. It makes for great headlines, and there have been quite a few of those this week.

What are hot pepper lovers (aka pepperheads) to make of this case report? Perhaps we need to become a bit more moderate in our quest for the hottest chili pepper in the world. If we are going to bite into a Carolina Reaper, it might be prudent to take the tiniest of tiny bites and not go for the gusto in one mouthful.

We do not think hot pepper lovers need to give up on hot chili peppers because of this one report. There are some potentially wonderful benefits from eating a hot pepper now and again. Here are some links to articles and the science behind scarfing down salsa:

Hot Pepper Lovers Live Longer So Fire Up Your Tastebuds

Hot Pepper Lovers Live Longer So Fire Up Your Tastebuds

How Hot Peppers Can Improve Your Health and Extend Your Life

How Hot Peppers Can Improve Your Health and Extend Your Life

Share your own hot pepper story below in the comment section. Do you find hot chili peppers helpful or hurtful? Have you ever had a “thunderbolt headache”? Have you ever gotten rid of a migraine with hot spicy soup or salsa? Please let others know about your hot pepper story.

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  1. Rick

    What does holocephalic mean? The only online definitions I came up with referred to a fetus.

  2. cmoo
    South Carolina

    Read on here recently about the benefits of capsaicin to lower blood pressure and the option of taking it in capsule form if not fond of the hotness. Bought 450mg Cayenne capsules and felt strange in the abdominal area after taking. Tried again in a few days with same effect. Tried pouring 1/2 the contents in soup; tried 1/2 empty capsule and finally was having burning in lower esophageal area and stomach area. each time taken with food. Stopped and started treating with malanta and got back to normal. In summary, it’s not going to help but hurt me so no hot stuff or capsaicin.

  3. Mary

    I went to a Mexican restaurant where they told me the sauce was not hot.

    My tongue said okay. My throat, I do not like this one bit.
    So I need to be careful even with minimally hot sauce

  4. JP

    Slightly off topic, but thank you very much for the description of “occipital headache”–mine were misdiagnosed for years. Lately they were 10 on the pain scale, and the pain caused me to pass out and vomit…in that order! I was treated badly because the headaches were classified as “tension” or “migraine” when they were actually pain from cervicocranial nerve compression caused by damage from prior whiplash injury. Radiofrequency neurotomy has made the headaches bearable… Thank you again, your information is (again) valued very much.

  5. Lia

    This looks like an odd case — usually capsaicin is a vasodilator.
    “Capsaicin (8-methyl-N-vannillyl-6-nonenamide), via binding to the vanilloid receptor subtype 1 (VR1), stimulates a subpopulation of primary afferent neurons that project to cardiovascular and renal tissues. These capsaicin-sensitive primary afferent neurons are not only involved in the perception of somatic and visceral pain, but also have a “sensory-effector” function. Regarding the latter, these neurons release stored neuropeptides through a calcium-dependent mechanism via the binding of capsaicin to the VR1. A subset of capsaicin-sensitive sensory nerves contains calcitonin gene-related peptide (CGRP) and substance P (SP). These sensory neuropeptides are potent vasodilators and natriuretic/diuretic factors.”

    See also:

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