A 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng was diagnosed with cerebral arteritis in the Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan. Ginseng root 25 gm stewed in rice wine was taken for fatigue associated with sore throat. An explosive headache with nausea and vomiting developed 8 hours later and was temporarily relieved by acetaminophen. Smaller quantities of ginseng had never caused headache. CT showed increased density over the falx, suggestive of subarachnoid hemorrhage. Cerebral angiograms revealed multiple areas of alternating focal constriction and dilatation (beading) in anterior and posterior cerebral arteries and superior cerebellar artery, consistent with arteritis. The headache gradually resolved within 10 days. 
COMMENT. The temporal association between the ingestion of the ethanolic ginseng extract and the onset of a severe headache was strongly suggestive of a causal relationship. The use of cocaine, amphetamine, phenylpropanolamine, and other sympathomimetic drugs was denied. Most ginseng users are not medically supervised, and adolescents and adults may be experimenting with doses larger than those generally recommended in Chinese practice (0.5 to 2 gm). The expected benefits are listed as prevention of aging or tiredness, improved stamina or concentration, and increased resistance to stress or disease.