Thunderclap Headache
World's Hottest Chili Pepper Ignites Thunderclap Headache 🌶️ A 34-year-old man competing in a chili pepper–eating contest experienced a sudden thunderclap headache after ingesting a single "Carolina Reaper," which is widely considered the world's hottest chili pepper. After experiencing dry heaves without vomiting, the man developed intense neck and occipital pain that become holocephalic. The excruciating pain drove him to seek emergency department care. He had at least two more episodes of brief thunderclap headache over the ensuing days. Initial diagnostic tests came back negative. His urine drug screen and noncontrast head and neck CT scans were unremarkable. He had no neurologic deficits, and his blood pressure was 134/69 mm Hg. Although CT angiography did not show an aneurysm, it did reveal a surprise. Doctors detected multifocal luminal narrowing in his left supraclinoid internal carotid artery, M1 segment of bilateral middle cerebral arteries, and P1 segments of bilateral posterior cerebral arteries — a finding consistent with vasospasm. After ruling out the common causes, including subarachnoid hemorrhage and cerebral vasculitis, neurologists considered reversible cerebral vasoconstriction syndrome, or RCVS, in the differential diagnosis of thunderclap headaches.
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