Go Ad-Free
logoThe People's Perspective on Medicine

Why Did Hot Pepper Headache Land Man in the Emergency Room?

Hot pepper lovers search for ever hotter chili peppers. The Carolina Reaper is dubbed the hottest pepper in the world. Beware a headache!

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.”

Sh0uld You Fear the Carolina Reaper?

The case we cite above is not the only case of hot pepper headache after eating a Carolina Reaper. An article in the journal Radiology Case Reports (April 5, 2020) describes another horrible headache story. The title of the article:

Fear the reaper:
reversible cerebrovascular vasoconstriction syndrome after hot pepper ingestion

The authors describe what happened and offer advice:

“The Carolina Reaper pepper is one of the spiciest edible peppers in the world. While localized symptoms such as mouth burning, mouth numbness, and even vomiting are the main risks of eating these peppers, recent case reports have revealed more serious complications of these potent foods. A 15-year-old healthy male ingested a Carolina Reaper pepper on a dare. Two days later, he developed an acute headache during football practice and was subsequently diagnosed with an acute cerebellar infarct and reversible cerebrovascular vasoconstriction syndrome. Reversible cerebral vasoconstriction syndrome should be considered in patients who present with severe headache after ingestion of ultraspicy peppers, and early treatment of reversible cerebral vasoconstriction syndrome should be initiated in patients with severe headache after pepper ingestion.”

People’s Pharmacy Perspective:

What are hot pepper lovers (aka pepperheads) to make of these case reports? 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 these two cases. 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

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.

Rate this article
4.5- 42 ratings
About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
Tired of the ads on our website?

Now you can browse our website completely ad-free for just $5 / month. Stay up to date on breaking health news and support our work without the distraction of advertisements.

Browse our website ad-free
Join over 150,000 Subscribers at The People's Pharmacy

We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.