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 After downing a "Carolina Reaper," billed as the world's hottest
chili pepper at the time, a 34-year-old man developed intense head
and neck pain and had several brief but excruciating headaches over
the next few days. Known as "thunderclap headaches," these episodes
are a medical emergency, because they can signal bleeding in the
brain, a clot shutting down brain blood flow, or other
life-threatening conditions.
Fortunately for the man, the pain came from so-called reversible
cerebral vasoconstriction syndrome (RCVS), a temporary narrowing of
the vessels that supply the brain with blood. RCVS usually does not
have long-term ill effects but can sometimes lead to stroke.
Certain substances - including capsaicin, the active ingredient in
chili peppers - can trigger blood vessel constriction, Dr.
Kulothungan Gunasekaran, a senior staff physician at Henry Ford
Health System in Detroit and one of the doctors who took care of
this patient, told Reuters Health in a telephone interview.
He noted that other teams have already reported two cases of heart
attack apparently due to capsaicin, one in a patient taking cayenne
pepper capsules for weight loss and another in a patient using a
capsaicin patch to treat pain.
In a report released April 9 by the publishers of BMJ Case Reports,
Gunasekaran and colleagues describe how the patient had started
having dry heaves after competing in a hot pepper contest. Over the
next few days he suffered thunderclap headaches, with excruciating
pain that eventually sent him to the emergency room.
Tests showed no sign of stroke or any other deadly headache causes,
and the man's blood pressure was normal. CT angiography, which
allows doctors to visualize blood vessels, showed narrowing of four
arteries delivering blood to the brain, suggesting RCVS.
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Repeat CT angiography five weeks later found the man's arteries had
returned to normal.
"People should be cautious about the effects of hot peppers,"
Gunasekaran said. "If they do develop these symptoms, they should
seek medical attention."
Dr. Aneesh Singhal of Harvard Medical School and Massachusetts
General Hospital in Boston was the first to describe RCVS, in 2001,
in a patient who developed thunderclap headaches after eating red
hot peppers. While about one-third of patients with RCVS will have
complications such as bleeding in the brain, Dr. Singhal noted,
"more than 90% of patients have an excellent outcome."
It's crucial that thunderclap headaches not be mistaken for
migraine, because migraine drugs can make RCVS worse, he told
Reuters Health in a telephone interview.
Energy supplements are another potential cause of RCVS, Dr. Rula A.
Hajj-Ali of Cleveland Clinic Lerner College of Medicine told Reuters
Health by phone. She noted that most of her RCVS patients are males
who use these supplements.
While most RCVS patients do well, she added, a minority can have
such severe blood vessel spasms that they die. "This is a common
cause of strokes in the young, and it is not benign," Dr. Hajj-Ali
said.
SOURCE: http://bit.ly/2GJALAg BMJ, online April 9, 2018.
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