The Carolina Reaper is the finale of every hot-pepper-eating competition worth its sauce. It’s the hottest pepper in existence, ranking 1.5 million on the Scoville Scale (jalapeños clock in between 1,000 and 10,000; scorchingly hot habaneros barely scratch 350,000). When you eat one, you expect to suffer. What you don’t expect is to continue suffering for days on end, ultimately landing in the ER as the Reaper constricts your brain’s arteries and inflicts excruciating headaches.
But that’s exactly what happened to one unfortunate chili-lover, as described in a recent case report. A 34-year-old man (whose identity remains confidential) wowed spectators in a hot pepper eating contest when he managed to swallow a whole Carolina Reaper. The man experienced dry heaves immediately after putting it in his mouth, which is fairly typical. But as the hours passed, he continued to feel intense pain in his neck and around his eyes, which then extended to his entire head. Over the next few days, he began to experience brief, intense “thunderclap” headaches.
The pain was so excruciating that the pepper aficionado found himself in the emergency room, where physicians ran a battery of neurologic tests — all negative, except for one. A CT scan showed that a handful of arteries in his brain had become constricted. He was diagnosed with reversible cerebral vasoconstriction syndrome — jargon that roughly translates to “reversible headaches caused by constricted brain arteries”. RCSV is usually caused by prescription medications or illegal drugs.
But in this case, the culprit was probably the Carolina Reaper. “No cases of RCVS secondary to peppers or cayenne have been previously reported, but ingestion of cayenne pepper has been associated with coronary vasospasm and acute myocardial infarction,” the authors write. “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.”
Fortunately, the man recovered. His symptoms resolved on their own, he had no further headaches, and a CT scan five weeks later demonstrated that the arteries in his brain were no longer constricted. All’s well that ends well. As to whether chili eaters should consider this a cautionary tale, it remains unclear whether we should fear the Reaper per se. Ann Ducros, professor of neurology at the University of Montpellier (who was not involved in the study) told CNN that pain and strong emotions can also trigger RCVS. “In the case of ingestion of pepper,” she says. “Perhaps it is the intense pain triggered by the pepper which triggered the RCVS and not the pepper itself.”