An emergency medicine researcher explains why these sudden and intense headaches need to be taken seriously.

Amanda MacMillan
April 10, 2018

There’s a cautionary tale in this week’s BMJ Case Reports journal, and it’s frightening enough to make anyone think twice about downing super spicy foods. According to doctors at Bassett Medical Center in Cooperstown, New York, a patient there developed excruciatingly painful headaches—known as thunderclap headaches—after eating the world’s hottest chili pepper.

It all started when the unidentified 34-year-old male entered a hot-pepper-eating contest, during which he consumed one Carolina Reaper pepper. The little red fruit was bred specifically for its spiciness, and it currently holds the Guinness World Record for the highest number of Scoville Heat Units, a measurement of chemical compounds called capsaicinoids.

The man immediately began dry heaving, which isn’t terribly surprising. But he also experienced several seconds of intense head and neck pain. The sudden pain was so bad—and returned several times over the next few days—that he wound up in the emergency room.

In the ER, a computed tomography (CT) scan showed that several arteries in the man’s brain were narrower than they should be, prompting his doctors to diagnose him with “thunderclap headaches” caused by a condition called reversible cerebral vasoconstriction syndrome (RCVS).

Luckily, the patient’s headaches went away on their own, and a second scan five weeks later showed that his arteries had returned to normal. But his experience raises several questions—like, what is a thunderclap headache, and is it dangerous? And is it normal to get them from spicy foods?

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According to Troy Madsen, MD, an emergency medicine researcher at the University of Utah, thunderclap headaches come on very suddenly and usually last less than five minutes. “They hit you just like a crack of lightning and that sound of thunder,” says Dr. Madsen, who was not involved with the hot-pepper case. “It’s all of a sudden, out of nowhere, 10-out-of-10 pain that reaches its maximum intensity within seconds.”

While some thunderclap headaches happen without a known cause and are considered benign, they can also signal an increase or decrease of blood flow to the brain. For example, they can occur as the result of a stroke, a hemorrhage following a head injury, or a sudden change in blood pressure. In about 10% of cases, Dr. Madsen says, it can signify a ruptured brain aneurysm.

“That’s what’s so concerning with these types of headaches that come on so quickly,” he says. “It’s different from someone who comes in with a history of migraines, or from another type of headache that comes on as a low rumble that gradually gets louder.”

In the BMJ Case Report story, the patient’s headaches were due to RCVS, a temporary condition in which blood vessels spasm and become narrow, limiting blood flow to the brain. Some people’s brains may be naturally prone to RCVS, but it can also be caused by some medications (including birth control pills), marijuana, or illicit drugs like cocaine and other stimulants. It’s also more common—and tends to be more severe—in women.

RELATED: 11 Health Risks Linked to Migraines

The case report authors say they can’t be sure that eating a Carolina Reaper caused those changes in the patient’s blood vessels and his subsequent headaches, and they note that this is the first case in scientific literature to link spicy food with problems like these.

But eating capsaicin, the chemical responsible for a pepper's heat, has been linked to heart attacks and sudden constriction of the coronary artery, the authors point out. Because the compound has been shown to affect blood vessels, they wrote in their paper, it’s “plausible” that it was also the culprit in this case.

Dr. Madsen tells Health that he’s never seen a thunderclap-headache case tied to spicy foods, but the possibility doesn’t surprise him. “I’ve definitely had people describe certain types of foods as triggers for other types of headaches,” he says. “For some people, it’s spicy foods, for others it’s things like chocolate or cheese.”

And while he hasn’t examined the case-report subject himself, he says it’s likely that this patient will be at heightened risk for headaches in the future. “For whatever reason, the blood vessels in his brain were clamping down,” he says. “He’ll probably want to be monitored by a neurologist now and try to identify triggers, whether it’s spicy food or something else.”

Other headache triggers can include sudden temperature changes, loud noises, and strenuous exercise. And while some people get thunderclap headaches with no apparent underlying health problem, Dr. Madsen says it’s always smart to get them checked out.

RELATED: 11 Surprising Headache Triggers

“If a patient comes in and says, 'I have this sudden severe headache, but this happens to me every month, and I’ve had all the tests done,' I’m less concerned,” he says. “But if it’s a first-time thing and someone has these symptoms, I’m definitely giving them a CT scan to look for bleeding in the brain or other serious problems.”

As for eating spicy foods? “When we’re talking about something that spicy, you always have to be a little careful—and if someone has an underlying issue, like cardiac or vascular disease, it’s possible that spicy food could trigger a stress response and make things worse,” Dr. Madsen says.

Eating super spicy peppers can also cause abdominal discomfort, numbness, and breathing difficulties. And if you vomit them up—a very real possibility—your stomach acid can also damage the esophagus. (This happened to another pepper-eating contest participant in 2016, who then spent 23 days in the hospital.)

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So what can we learn from this unfortunate incident? First, spicy foods may be best consumed in moderation. But perhaps more importantly, if you do experience one of these thunderclap headaches—peppers or no peppers—see a medical professional, stat.

“If it comes on that quickly and it’s unlike any headache you’ve ever had before, you really need to get it checked out, even if it feels better a few minutes later,” says Dr. Madsen. “These are higher-risk headaches, and their underlying conditions may need immediate treatment, so it’s better to be safe than sorry.”