Hiccups are perhaps one of the most common reflexes of the human body. Most people experience hiccup bouts or persistent hiccups, which are generally benign and mildly-to-moderately disruptive. But in rare cases, chronic intractable hiccups can be incapacitating and can cause substantial damage.
There are approximately 4,000 hospital admissions for hiccups in the United States each year. Experiencing hiccups frequently, while rarely cause for serious concern, can nevertheless degrade quality of life. Fortunately, there are a variety of practical, proven ways to get rid of occasional bouts of hiccups. If, however, you are experiencing chronic, persistent hiccups, that can be a sign of a serious underlying medical condition that may require more extensive medical treatment. In these cases, it's best to consult a health care professional for a personalized evaluation.
In this article, we will first explain the mechanical cause of hiccups, then discuss factors known to trigger hiccups as well as potential hiccup-related complications, and last but not least we will share home remedies for hiccups as well as how to know when you should seek medical advice.
In anatomical terms, hiccups can be described as sudden, involuntary contractions of the diaphragm muscle. When this muscle contracts, it causes the vocal cords to snap shut, which produces the familiar, frog-like hiccup sound.
To deepen our understanding of hiccups, it's helpful to note that the primary function of the thoracic diaphragm muscle within the respiratory system is to separate the chest from the abdomen. The diaphragm also helps to control breathing. The sudden spasms that cause hiccups occur when both the diaphragm and intercostal (chest) muscles contract, which represents the end result of what researchers call the “hiccup reflex arc.” This arc is comprised of central nervous system signal transmissions sent along sensory and motor nerve fibers among the central processing unit of the midbrain, stomach muscles, and chest muscles.
Typically, diaphragmatic reflexive jerks repeat erratically or rhythmically over a span of several minutes or less. Laryngeal vocal cords shut rapidly less than a full second after each spasm, leading to a sudden surge of air into the lungs, which is what produces the “hic” sound. Hiccups occur more prevalently in babies and become less common as people age. There is a popular belief that human hiccups are an evolutionary remnant of a defensive reflex in amphibians.
What Causes Hiccups?
Although the underlying mechanisms for hiccups is not entirely clear, scientists have considered psychological, external, organic, and disease-related causes of hiccups. Hiccups in a suckling infant may be a protective mechanism necessary for an underdeveloped digestive system. The presence of trapped air may stimulate sensory fibers in a suckling baby’s stomach, triggering the hiccup reflex arc, which essentially burps the infant. Overfeeding, sudden changes to temperature, strong emotions, fatigue, and malnutrition may also induce hiccups in infants.
Surgery of the abdominal region, particularly in combination with general anesthesia, may cause hiccups in babies as well as adults. One study found that male patients who have recently undergone esophagogastoduodenoscopy (EGD) or bidirectional endoscopy with sedation are more likely to experience hiccups than are male patients without sedation for these procedures.
A common reason for hiccups in adults is believed to be trapped air bubbles in the stomach. A current or previous history of narcotics use and gastrointestinal disease also seems to correlate with an increased frequency of hiccup bouts. Other suspected causes for mild-to-moderate hiccups in adults (some of which, you will note, overlap with those in infants) include:
- Eating too fast
- Intense emotion
- Spicy foods and carbonated drinks
- Excess alcohol use
The most common cause of long-term hiccups, by far, is medication. The chemotherapy drug cisplatin is one medication widely believed to induce intractable hiccups. Antiemetic medications used in conjunction with chemotherapy drugs, such as dexamethasone, are also risk factors for hiccups. As an incidental reflex to treatment, hiccups may hinder healing during chemotherapy. A 2013 study published in the journal The Oncologist suggests replacing dexamethasone with the steroid methylprednisolone to lower the incidence of hiccups in patients.
It appears, too, that the side effects of pharmaceuticals which act upon neurotransmitters involved in the hiccup reflex arc may include chronic hiccups. These neurotransmitters include serotonin, gamma-aminobutyric acid (GABA), dopamine, epinephrine, acetylcholine, histamine, and norepinephrine. The hypnotic eszopiclone appears to cause intermittent hiccups, as detailed in a 2014 study. Some steroids and drugs used to treat Parkinson’s disease also increase risk.
In other cases, hiccups may result from an underlying medical condition. Here is a list of illnesses that can increase the risk for long-term hiccups:
- Gastroesophageal reflux disease (acid reflux)
- Kidney disease and kidney failure
- Nerve damage, particularly to the phrenic nerve and the vagus nerve
- Myocardial ischemia
- Herpes infection
- Multiple sclerosis
- Lesions or tumors on the structures involved in the hiccup reflex arc
It has been reported that, among adults, males experience chronic hiccups more than females do. Greater height was also a risk factor for the incidence of hiccups, according to the same study.
What Complications Are Associated with Persistent and Chronic Hiccups?
Persistent hiccups is the clinical term used to describe any bout of hiccups lasting more than 48 hours, while prolonged, chronic, or intractable hiccups refers to those lasting for more than 2 months.
Experiencing too frequent or chronic hiccups can decrease quality of life. A 2007 case report suggests that persistent hiccups are common during patient rehabilitations and may disrupt patient participation and progress, subsequently lengthening hospitalization.
Dealing with chronic hiccups can be discouraging and highly disruptive. It's common for those suffering from persistent or chronic hiccups to develop co-occurring conditions, such as:
- Depression and anxiety
- Pain (especially of the chest, abdomen, and throat)
- Difficulty eating and drinking
- Gastrointestinal reflux
- Decreased appetite
- Amino acid metabolism disorders (e.g., nonketotic hyperglycinemia)
- Weight loss
- Decreased libido
- Speech problems
- Difficulty sleeping
- Difficulty breathing
If your hiccups are manifesting as one of the health conditions mentioned above, it may be advisable to supplement with essential amino acids.
20 Proven Ways to Stop Hiccups
First, we'll cover time-tested home remedies appropriate for dealing with the average case of hiccups. Then we'll cover what to do when you suspect your hiccups may stem from an underlying medical problem.
It's likely you've heard of some of these remedies before, such as drinking a glass of water or breathing through a paper bag. It's common for people to find that one remedy treats their hiccups more effectively than the others, so if the first option you try does not resolve your problem, simply move down the list.
The 20 best non-pharmacological remedies and folkloric therapies for treating hiccups include:
- Drinking ice-cold water
- Drinking water while upside down
- Experiencing an acute stress response (typically generated by shock or surprise)
- Breathing in and out of a paper bag
- Placing a small piece of paper beneath the upper lip while breathing through the mouth
- Holding the knees to the chest and gently rocking backward and forward
- Gently stretching the chest muscles and diaphragm
- Holding the breath (which increases carbon dioxide concentrations in the lungs)
- Chewing gum or sucking on candy
- Placing sugar beneath the tongue and allowing it to dissolve there
- Eating peanut butter
- Focusing one's attention on an object
- Gargling with warm salt water
- Inducing sneezes
- Swabbing the ear canal with a local anesthetic
- Pinching the shoulder muscles
- Taking the tip of the tongue between the fingers and tugging on it
The treatments described above can even successfully treat persistent cases of hiccups. But if you experience intractable hiccups, meaning they last for 2 months or more, your should seek medical attention.
During the initial examination, your doctor will likely concentrate on determining which tests are more appropriate to identify the root cause of your hiccups. CT scans and chest X-rays can detect structural issues, for example, magnetic resonance imaging (MRI) can locate tumors or other lesions, and endoscopic tests suss out esophageal abnormalities. It may also be useful to conduct blood tests to look for any hormonal imbalances, metabolic disorders, or infections that may disrupt neural activity.
While intractable hiccups may affect quality of life, very rarely are they life-threatening. That said, if your hiccups are accompanied by severe abdominal pain, vomiting, fever, shortness of breath, spitting up blood, or feeling as if your throat is closing up, you should seek immediate medical care.
In the absence of such urgent symptoms, it is nevertheless important to control chronic hiccups symptoms. This is especially in clinical environments where rehabilitation may be compromised by adverse effects.
Treating chronic hiccups usually requires medication administered under a physician’s supervision. The pharmaceutical chlorpromazine is usually the first choice, but it is not always an effective chronic hiccups cure. Metoclopramide and haloperidol are other conventional options. Metoclopramide, a gastrointestinal stimulant, influences acetylcholine neurotransmission. Haloperidol is a sedative and anti-psychotic that helps to stabilize neurotransmitters.
Certain drugs related to GABA—barbiturates, benzodiazepine, and propofol—induce hiccups; yet, baclofen, gabapentin, and the anticonvulsant agent valproic acid are used to treat hiccups by regulating GABA in the nervous system. Phenytoin and carbamazepine are other anticonvulsant agents used in the treatment of hiccups.
In addition to GABA and acetylcholine antagonists, there are other medicines that control neurotransmitters of the nervous system to help suppress the hiccups reflex arc. These drugs include olanzapine and risperidone to control serotonin, and omeprazole to regulate histamine. The use of pharmacological agents (especially sedatives) to effectively treat intractable hiccups does have drawbacks—often, the dose required may be substantial enough to impair movement and/or cognitive function.
For hiccups caused by a structural issue, surgical remedies can be used to identify, localize, and remove the lesions inducing the hiccups. In some instances, it may be necessary to remove tumors involved with the hiccups reflex arc in conjunction with pharmacotherapy. Another promising physical intervention is digital rectal massage, which has proven effective in eradicating intractable hiccups.