Man enters chilli-eating contest. Chilli wins

As readers who have had the dubious pleasure of watching combative cooking-themed television shows such as Man v. Food already know, sometimes the simple act of eating can take on an unpleasant aspect of machismo and challenge.

Eating enormous hamburgers or entire turduckens might be favourite pursuits for large gentlemen with loud voices and even louder shirts, but true food warriors know that the ultimate contest between humans and comestibles involves eating simple, uncooked, untreated chillies.

Some people like to do this sort of thing in private – testing their powers of endurance for reasons only they know – while for others competing against fellow hot-pepper fanatics is the name of the game. In both scenarios, however, there is only one paradigm: the hotter, the better.

And, of course, it’s all good, clean fun until someone gets hurt – which is precisely the point at which the British Medical Journal gets involved.

In the latest edition of the journal’s Case Reports, four New York-based emergency doctors, led by Satish Kumar Boddhula, report on a man who experienced crippling “thunderclap headaches” after attempting to eat a ‘Carolina Reaper’, billed as the hottest chilli in the world.

Chillies are measured on the Scoville Scale, in increments known as scoville heat units, or SHUs. The scale is named after a pharmaceutical researcher, Wilbur Scoville, who worked for Parke Davis and died in 1942.

Effectively, the Scoville Scale reflects the concentration of capsaicin, a neuropeptide-releasing agent found in all members of the pepper family. A capsicum, the baseline pepper, has one SHU. A bird’s eye chilli – small and hot enough for most spice-lovers – contains up to 225,000.

The Carolina Reaper contains 1,569,300.

The 34-year-old man who presented to Boddhula and his colleagues at the Bassett Medical Centre in New York presumably knew that. It was, indeed, probably the reason he chose to tackle the fruit at a chilli-eating contest in the first place.

By the time he arrived at the emergency department, two days of sheer misery had elapsed since his display of culinary masochism. Immediately after eating the chilli, the case study notes reveal, he started dry-heaving.

The description continues: “He then developed intense neck and occipital head pain.” After that he experienced multiple thunderclap headaches: brief bouts of excruciating pain that sent him scurrying to the hospital.

Once there, he was tested for a variety of neurological conditions, including aneurism, but everything came back clear. A computed tomography (CT) scan, however, revealed that several of the arteries leading to his brain were constricted.

Boddhula and colleagues diagnosed a condition known as reversible cerebral vasoconstriction syndrome (RCVS). As the name implies, the artery restrictions gradually eased and the headaches disappeared.

After five weeks, the man was found to be symptom-free. It is unknown whether he plans a return match with the chilli from hell.

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