Monday, April 9, 2018

Chili induced headaches-reversible cerebral vasoconstriction syndrome


A man bit off more than he could chew when he tackled the world's hottest chili, the so-called “Carolina Reaper,” and was left with excruciating headaches.

In the first ever recorded such case, the next few days after eating the veggie the man experienced short splitting pains lasting seconds at a time.

The 34-year-old, who was not identified, had eaten just one of the chilies at a chili eating contest in upstate New York. 

Immediately after the competition, he began dry heaving and developed intense neck and head pain starting at the back, which later spread across the whole head.

He then developed crushingly painful headaches and at one point he decided to go to the emergency room.

The patient told doctors he did not have any tingling sensation or weakness, slurred speech or transient loss of vision, and he had just a slightly high blood pressure of 134/69mm Hg.

Tests for various neurological conditions came back negative, until scans revealed several arteries in his brain had constricted.

This prompted doctors to diagnose him with thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS) — a temporary artery narrowing often accompanied by thunderclap headache.

"RCVS is characterized by multifocal cerebral arterial constriction that resolves within days to weeks and often presents with a thunderclap headache,” Dr. Kilothungan Gunasekaran, from New York’s Bassett Medical Center, explained.

He said RCVS can occur without an identifiable cause, as an idiosyncratic reaction to certain medications (ergotamine, selective serotonin reuptake inhibitors, alpha– sympathomimetic decongestants and triptans) or secondary to an illicit drug (cocaine, amphetamines and ecstasy).

"No cases of RCVS secondary to peppers or cayenne have been previously reported," he said, "but ingestion of cayenne pepper has been associated with coronary vasospasm and acute myocardial infarction,” he added.

The man's symptoms cleared up on their own and a CT scan five weeks later showed the affected arteries had returned to their normal width.

http://www.foxnews.com/health/2018/04/09/man-who-ate-worlds-hottest-chili-is-hospitalized-with-excruciating-headaches.html

2 comments:

  1. Satish Kumar Boddhula, Sowmya Boddhula, Kulothungan Gunasekaran, Edward Bischof. An unusual cause of thunderclap headache after eating the hottest pepper in the world – “The Carolina Reaper”.
    BMJ Case Reports 2018; doi:10.1136/bcr-2017-224085

    Description
    A 34-year-old man with no significant medical history presented to the emergency room (ER) after an episode of thunderclap headache. His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest where he ate one ‘Carolina Reaper,’ the hottest chili pepper in the world. He then developed intense neck and occipital head pain that became holocephalic. During the next few days, on at least two occasions and in retrospect he thought probably more often, he experienced brief intense thunderclap headaches lasting seconds. The pain was excruciating and thus he came to the ER. He denied any focal tingling sensation or weakness, slurred speech, or transient loss of vision. Physical examination revealed blood pressure of 134/69 mm Hg and no neurological deficits. Urine drug screen and non-contrast CT head and neck were unremarkable. 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 (figure 1A). A presumptive diagnosis of thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS) was made based on the clinical presentation of a severe acute headache, exclusion of aneurysmal subarachnoid haemorrhage, and segmental cerebral arterial vasoconstriction on CT angiography. Our patient’s symptoms improved with supportive care, he had no further thunderclap headaches, and repeat CT angiography 5 weeks later demonstrated resolution of luminal narrowing consistent with RCVS.

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  2. 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 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 recalled.

    The Reaper has been measured at more than two 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’s 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 one to ten 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 nonfatal 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 phone at the PuckerButt Pepper Company in Fort Mill, S.C., 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 wasn’t such a bad thing. “We eat them all the time,” he said, with no ill consequences beyond pain.

    https://www.nytimes.com/2018/04/09/health/hot-pepper-thunderclap-headaches.html

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