Patient Develops Thunderclap Headaches After Consuming ‘Carolina Reaper’

The authors note that this appears to be the first case of RCVS secondary to pepper or cayenne ingestion.

A new report published in BMJ Case Reports describes a case of reversible cerebral vasoconstriction syndrome (RCVS) caused by ingestion of the hottest chili pepper in the world, the ‘Carolina Reaper’.  

The patient, a 34-year-old male, presented to the emergency department after experiencing excruciating headaches days after participating in a hot pepper eating contest. At this event, he consumed one ‘Carolina Reaper’ and subsequently developed intense neck and occipital head pain.

A diagnosis of thunderclap headache secondary to RCVS was made after “CT angiography revealed no aneurysm but demonstrated unexpected multifocal luminal narrowing in the left supraclinoid internal carotid artery, M1 segment of bilateral middle cerebral arteries, and P1 segments of bilateral posterior cerebral arteries consistent with vasospasm.” The patient was given supportive care and the thunderclap headaches eventually abated. A CT angiography conducted 5 weeks later showed resolution of luminal narrowing.

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In their discussion of the case, the authors note that this appears to be the first case of RCVS secondary to pepper or cayenne ingestion. Given the circumstances of this case, they recommend RCVS be considered in the differential diagnosis in patients who present with thunderclap headache after cayenne pepper ingestion.

Medications such as selective serotonin reuptake inhibitors, triptans, and alpha-sympathomimetic decongestants can also cause RCVS, however, in this case, given that the patient’s symptoms began immediately after he ate the pepper, the authors believe ingestion of the ‘Carolina Reaper’ was the likely cause.

Removal of the offending agent and supportive care are generally considered primary treatment, although calcium channel blockers (CCBs) are often used. However, evidence as to whether CCBs improve clinical outcomes in RCVS is still lacking.

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