He ate the world’s hottest chilli pepper, then landed in hospital

If you eat a really hot chilli pepper, you expect pain. A lot of pain.

In addition to the feeling that you have just put a live coal in your mouth, you may weep, vomit and wonder where in your life you took a wrong turn.

You don't expect a headache so intense and immediate that it sends you to the emergency room. But that's what happened to a 34-year-old man who turned up at a New York hospital with what clinicians call a thunderclap headache.

His problems began when he ate a whole Carolina Reaper — the hottest chilli pepper in the world, according to Guinness World Records — while participating in hot-pepper-eating competition.

He immediately started experiencing dry heaves — not unknown in the hot-pepper-eating world. But then a pain in his neck and head came on like ... a thunderclap.

It passed, but over the next few days he experienced more thunderclap headaches — that is the clinical term — so he sought medical attention.

Scans of his head and neck showed the kind of constriction in some arteries that can cause intense headaches, doctors reported in BMJ Case Reports. The scientific term for this temporary narrowing of arteries is reversible cerebral vasoconstriction syndrome.

Dr Kulothungan Gunasekaran, one of the report's authors, now at the Henry Ford Hospital in Detroit, said that for some reason the man must have been particularly sensitive to capsaicin, the heat-producing ingredient in peppers. The Carolina Reaper is a popular pepper, and many people eat them and experience nothing worse than the desire to cut out their own tongues.

"I was discussing the case with a nurse who had eaten three Carolina Reapers," Dr Gunasekaran said.

The Reaper has been measured at more than 2 million Scoville heat units, the accepted scale for how hot peppers are. Measurements vary, but a really hot habanero might come in at 500,000 Scoville units.

The patient was fine, with no lingering damage, but thunderclap headaches are not to be dismissed. For one thing, there is the pain, which seems to surpass even the normal effect of the peppers.

Dr Lawrence C. Newman, a neurologist and director of the headache division at NYU Langone Health, said: "On a 1 to 10 scale, it's off the charts." And it can indicate the kind of stroke that results from bleeding in the brain.

It happens instantaneously. If that kind of headache hits you, it makes sense to seek medical attention "whether you've bitten into a pepper or not," Dr Newman said.

The new study does suggest that capsaicin, being investigated for its role in alleviating pain and lowering blood pressure, can have unexpected effects on certain people.

Cayenne pepper pills and a capsaicin patch, sold in China and Turkey, have been blamed in medical reports for two non-fatal heart attacks in young men, the result of spasms in arteries.

But "we are not advising anything against the Carolina Reaper," Dr Gunasekaran said.

The Reaper was bred to reach record levels of heat. Reached by telephone at the PuckerButt Pepper Company in Fort Mill, South Carolina, the Reaper's creator, Ed Currie, offered mixed advice on pepper consumption.

On the one hand, he said, "people who eat whole Reapers are just being stupid". But "Smokin' Ed", as he calls himself, also gave the impression that was not such a bad thing. "We eat them all the time," he said, with no ill consequences beyond pain.

Mr Currie indulges in other competitions of suffering. For instance, he said, he had recently taken the Death Nut Challenge, which involves eating insanely hot peanuts. He has a partnership with a company that produces them.

"I knew beforehand I shouldn't do it," Mr Currie said. "I was in pain for two hours."

For the average person interested in spice, not suffering, he advised using small amounts of any really hot pepper in food preparation, as they were intended.

So if you happen to go beyond your limits — having, say, entered a hot-pepper-eating competition?

"Citric acid seems to work the best to alleviate the pain," he said. "Don't chug milk because you'll just throw it up."

The cause?

Spasming blood vessels in his brain, likely due to the super hot pepper, according to a paper published in BMJ Case Reports today.

Thunderclap what now?

Thunderclap headaches are relatively rare, and likely only strike those with a genetic predisposition, Royal Melbourne Hospital neurologist Mark Parsons said.

But if you get one, you'll know about it.

"They're really intense, like the worst headache ever, and maximal severity right at the onset," Professor Parsons said.

"It can make you collapse or pass out with the intensity. It's like being hit in the back of the head with a cricket bat.

"You'd usually need injectable painkillers at the hospital to relieve it. Your standard paracetamol or anti-inflammatory won't help."

These epic headaches can be triggered by a range of conditions, such as bleeding around the brain called a subarachnoid haemorrhage.

For some, they can strike during orgasm, Professor Parsons said: "Blood pressure rises and an artery ruptures.

"If you get a thunderclap headache during sex, you should probably seek medical attention."

But the underlying cause isn't always life-threatening.

Shrinking arteries

When the Carolina Reaper snacker went to the emergency room, brain scans ruled out bleeding.

What they did show was that several arteries had narrowed — a phenomenon called vasoconstriction or vasospasm.

This led to a diagnosis of "thunderclap headache secondary to reversible cerebral vasoconstriction syndrome [RCVS]", the case study's authors wrote.

RCVS doesn't always have an obvious cause. It can be a reaction to certain medications, such as anti-depressants, and illicit drugs like ecstasy.

And vasoconstriction on its own shouldn't be painful, Professor Parsons said. The agony is probably due to brain chemicals called neurotransmitters suddenly shifting, especially in the pain areas.

Anti-depressants, drugs and yes, orgasms, can give neurotransmitter levels a boost.

"If your brain floods with dopamine, an excitatory neurotransmitter, that probably triggers the vasospasm and pain pathways in the brain, if you're predisposed," Professor Parsons said.

So, should I stop eating hot chillies?

No, Professor Parsons said: "This is the first time it's been reported from eating chilli, and a lot of people in a lot of cultures consume a lot of chilli, so it must be pretty rare."

And as for the man in the case study, his thunderclap headaches went away on their own.

A brain scan five weeks later showed his arteries had returned to normal.

No mention of whether he resumed his competitive chilli-eating career, though.