That narrowing, in turn, led to the thunderclap headaches, the authors said.
If true, this would be unprecedented. As the study’s authors wrote, hot peppers have never previously been suspected of causing RCVS, which means, of course, that this is big news.
There’s only one problem: The authors may have been too quick to pin the blame on the Carolina Reaper. Other experts in the field of neurology and headache research say that there’s no clear evidence that capsaicin, the active ingredient in chile peppers, causes a narrowing of arteries. Nor does RCVS always lead straight to thunderclap headaches, which cause “incapacitating” pain that “brings people to their knees,” said David Dodick, chairman of the American Migraine Foundation. On a pain scale of one to 10, Dodick gives a thunderclap headache a solid 10.
A few days after gobbling down the whole Carolina Reaper during a hot-pepper-eating contest, the patient in the study at least twice “experienced brief intense thunderclap headaches lasting seconds,” the report noted. The pain was intense enough that the man wound up at the Bassett Medical Center in Cooperstown, N.Y.
The common jalapeño pepper tops out at about 8,000 Scoville heat units, or SHUs, the principal measure of a chile pepper’s heat. But the Carolina Reaper, which was developed by the PuckerButt Pepper Co. in South Carolina, averaged 1.64 million SHUs in tests conducted by Winthrop University in South Carolina.
The most recent tests, done over a three-year period, officially confirmed the Reaper’s status as hottest pepper on the planet, according to Guinness World Records. Ed Currie, founder of PuckerButt and the mad scientist behind the hybrid Carolina Reaper, said all the recent buzz has only increased interest. Orders for Reaper seeds, dried peppers and hot sauces have more than doubled from the previous week, he said.
To people of a certain disposition — thrill-seekers, daredevils, folks who never want to taste their food again — the Carolina Reaper is the Mount Everest of foodstuffs. It must be conquered. Countless souls have entered contests to try to tame the Reaper. Some can pop them like candy and exhibit only mild frat-boy symptoms. Others are reduced to drooling, howling, semi-delirious organisms that can no longer function on their own.
The man in the study was something else. He started experiencing neck and head pains. Then came the thunderclap headaches. The man’s primary physician, neurologist Dr. Gregory Cummings, performed an angiogram, which showed no signs of a brain aneurysm but revealed an “unexpected” narrowing of certain cerebral arteries, according to the study. As the name implies, RCVS resolves itself within days or weeks, although a person with the condition might experience thunderclap headaches along the way.
After ruling out drugs and some other potential causes, the study’s authors turned their attention to the Reaper. They discovered two case reports (including one cited in the study) that found cayenne pepper pills used for weight loss have been tied to heart attacks and the narrowing of coronary arteries. “So that’s the reason we’re thinking it’s possible that this could have been due to the hot pepper, the Carolina Reaper,” said Kulothungan Gunasekaran, the lead author and a doctor of internal medicine at Henry Ford Hospital in Detroit.
But Dodick, professor of neurology at the Mayo Clinic, said capsaicin typically causes blood vessels to dilate, not constrict. Think about how your face can turn red, Dodick noted, after eating something spicy. That’s capsaicin dilating your capillaries, the smallest blood vessels in the body.
Just as important, Dodick said, the narrowing of cerebral arteries does not automatically lead to thunderclap headaches. In other words, just because the man had narrowed brain arteries doesn’t mean they caused his headaches. Twenty-five percent of patients who experience thunderclap headaches, Dodick said, don’t have RCVS at the start, although it may develop days or weeks later. What’s more, nearly half of patients continue to have thunderclap headaches after the RCVS has resolved. RCVS and thunderclap headaches “may be parallel phenomena from the same inciting event,” Dodick said.
Dodick suggested another cause for the patient’s RCVS: The sympathetic nervous system, which is responsible for our “fight or flight” response and, when activated, will constrict blood vessels. “When you experience pain, your sympathetic nervous system kicks in,” Dodick said.
What’s more, said Nauman Tariq, director of the Headache Center at Johns Hopkins Hospital, “Millions of people in some parts of Asia eat hot chiles as part of their diet. . . . But no other studies have reported this association with eating the hot chiles, let alone RCVS.”
But at the same time, Tariq pointed out in an email that capsaicin has been shown, in at least one study, to impact the vascular smooth muscle, which can narrow the arteries. So whether the patient’s RCVS was triggered by the pepper or his flight-or-fight response, he wrote, “the scientific evidence is not strong enough for people to discontinue this [pepper’s] use at this time just because of one particular case.”
When presented with the argument that the sympathetic nervous system could have triggered the patient’s RCVS, Gunasekaran was not defensive. “That’s possible,” he said. “Any high stress could cause sympathetic activity that could also cause vasoconstriction.”
“Our case is the first case,” he added. “It opens up an opportunity for a lot of research in this field.”
Now comes the really worrisome news: Currie with PuckerButt has already submitted an application to Guinness for an even hotter pepper. He calls the hybrid Pepper X, and tests conducted over the past five years indicate that it will blow away the Carolina Reaper, Currie said. On the high end, Pepper X averaged 3.189 million SHUs during one year of tests. On the low end, it averaged 2.5 million SHUs.
A group of people who recently tried Pepper X all threw up, Currie said. “It’s not a pleasant experience unless you’re used to it.”