The Guinness Book of World Records proclaimed the Carolina Reaper, bred by Ed Currie in Fort Mill, South Carolina, to be the hottest pepper in the world in November of 2013. Scientists measure the concentration of the chemical compound capsaicin — the component that produces the “hot” in hot peppers — in peppers and in other spicy foods. The higher the concentration, the higher the heat units on what’s called the Scoville scale. The Carolina Reaper’s heat was measured at 1,569,000 units. That’s nearly one million units hotter than the infamous Ghost Pepper, which comes in at 600,000 units and which held the title for hottest pepper way back in 2007. For comparison’s sake, a jalapeño pepper is 4,000 units.

‘Worst Headache of My Life’

The Carolina Reaper is insanely hot, but why did it land an otherwise healthy 34-year-old man in the hospital? There are scores of people in contests and on YouTube who eat the same variety of pepper with lots of pain and burning, but no ER visit. Doctors reported the episode on April 9, 2018, in the journal BMJ Case Reports. The man began dry heaving immediately after consuming the pepper. After that, he experienced his first thunderclap headache, followed by at least two more over the next few days before going to the hospital. Nauman Tariq, bachelor of medicine and bacholor of science, and director of the headache center at John Hopkins Hospital in Baltimore, describes a thunderclap headache as a severe, abrupt-onset headache. “It reaches its peak intensity within a minute, and the pain is described as very sharp, as if lightning struck the head. In some cases, patients describe the feeling as their head is exploding from the inside,” Dr. Tariq says. Tariq adds that even if the thunderclap headache happens to a person with a history of migraines, they would typically describe it as the “worst headache of my life.”

How Does Eating a Hot Pepper Cause a Headache?

After reviewing scans of the man’s head and neck, the authors of the BMJ case report found evidence of constriction in some arteries, known as RCVS, or reversible cerebral vasoconstriction syndrome. Their conclusion? It’s possible that the patient developed RCVS due to the consumption of the Carolina Reaper. That diagnosis may be correct, says Tariq, but there are unanswered questions. “The argument against this conclusion is that millions of people in some parts of Asia eat hot chili as part of their diet (Thailand, for example), but no other studies have reported this association of headache with eating the hot chili — let alone RCVS,” he says. He points out that the scientific literature regarding the direct impact of capsaicin on the arteries have shown variable results in different studies. “My take on this study is that it’s probable that there were several factors that could have contributed in triggering RCVS: anxiety, along with the anticipatory stress of eating the pepper, and the sharp and extremely unbearable taste,” says Tariq. He adds that if the man was a “chili-naïve person” and was trying it for the first time in large amounts due to the contest, it could have been part of what triggered the response.

The Psychology of Chili-Eating Contests

If this scenario is true, why would a person with no chili-eating experience dare to enter a contest and try to eat the hottest pepper in the world? While it’s not possible to know this particular individual’s motivation, Stephen Garcia, PhD, associate professor of psychology at the University of Michigan in Ann Arbor, suggests one possible explanation could be the Dunning-Kruger effect. This term describes the phenomena in which people tend to overestimate their own abilities in many areas where they have little to no knowledge, which can lead to poor choices and wrong conclusions. It’s like the expression, “You don’t know what you don’t know.” For some people, this unknown can translate into overconfidence. The competitive nature of the hot pepper eating contest could be a factor as well, says Dr. Garcia. “People are inclined to compete, especially if they think it will improve their standing in an area that is self-relevant.” That is, if you relate to being tough or being able to withstand pain, a hot pepper eating contest may appeal to you to try to increase your social standing.

Go Ahead, Eat Hot Chili Peppers

The good news, according to Tariq, is that this episode alone shouldn’t deter you from eating hot peppers. “The scientific evidence is not strong enough in this one particular case for people to discontinue this spice’s use,” he says.