Hiccups

Hiccups are involuntary spasms of the diaphragm (the muscle under the lungs). Hiccups are usually short-lived, but they can be chronic (long-lasting) in rare cases. Men are more likely to get hiccups than women, but nearly everyone will experience hiccups in their lifetime.

Although the exact cause of hiccups is unknown, there are several contributing factors. In addition to home remedies, hiccups can be treated medically. Complications from hiccups can occur if not treated properly.

This article will review the symptoms, causes, and treatment of hiccups.

Symptoms of Hiccups

When a spasm occurs in the diaphragm, the air is quickly sucked into the lungs, causing the vocal cords to close abruptly—resulting in the familiar "hic" sound. During a hiccup, the intercostal muscles (muscles between the ribs) contract, causing the ribs and abdomen to be pulled in. Over time, this movement can become uncomfortable.

Hiccups can come in clusters or occur just once. Often the interval between each hiccup is similar in timing. Most hiccups will resolve within 48 hours; however, intractable hiccups can last for months. Medical intervention is required for intractable hiccups.

Causes of Hiccups

Although the exact reason for hiccups is not fully understood, several contributing factors exist.

Acute hiccups (lasting less than 48 hours): The stomach sits below the diaphragm. When the stomach becomes distended from quick inhalation (breath) or the diaphragm is irritated, hiccups can occur. Here are common causes of acute hiccups:

• Gulping soda
• Eating or drinking quickly
• Overeating
• Eating spicy food
• Alcohol consumption
• Smoking
• Heartburn
• Eating foods of different temperatures in the same setting

Chronic or Intractable Hiccups (lasting more than 48 hours): In some cases, hiccups can indicate a serious medical issue. The following are conditions that can lead to intractable hiccups.

• Central nervous system disorders: Stroke, head trauma, brain tumors, hydrocephalus, and multiple sclerosis (MS)
  
• Infection: Meningitis, brain abscess, encephalitis, pneumonia, abdominal abscess, tuberculosis, herpes zoster, and COVID-19
• Nerve irritation: Goiter, neck tumor or cyst, laryngitis, and foreign body involvement
• Gastric issues: Gastritis, peptic ulcer, stomach cancer, gallbladder disease, hepatitis, bowel obstruction, and inflammatory bowel disease
• Thoracic conditions: Enlarged lymph nodes, asthma, chest trauma, and pulmonary embolism
• Cardiovascular disorders: Heart attack and pericarditis
• Metabolic: Diabetes mellitus and decreased calcium, sodium, and carbon dioxide levels in the blood
• Postoperative: General anesthesia, intubation, stretching the neck during intubation, and gastric distension
• Medications: Methyldopa (blood pressure medication), general anesthesia, chemotherapy agents, dexamethasone (steroid), and valium
• Psychogenic: Anorexia nervosa, excitement, stress, and schizophrenia
  

How to Treat Hiccups

Acute hiccups typically resolve independently; however, several home remedies can speed up the process. In contrast, chronic or intractable hiccups may need to be treated with medication, medical procedures, or alternative therapies.

Home Remedies

Home remedies are designed to relieve hiccups by eliminating diaphragmatic spasms, increasing carbon dioxide levels, and stimulating the vagus and phrenic nerves.

Here are some easy and inexpensive ways to treat hiccups at home:

• Breath-holding for five to 10 seconds
• Performing the Valsalva maneuver
• Biting into a lemon
• Swallowing a teaspoon of dry sugar
• Pulling on the tongue
• Pressing on the eyeballs
• While sitting - pull knees to the chest and hold for 30-60 seconds
• Drinking water through a rigid straw or valve

Medical Treatments

Although treating the underlying condition is essential to curing intractable hiccups, there are medical interventions that can help alleviate the symptoms.

Medications include:

• Antipsychotics: Chlorpromazine (FDA approved for hiccups), haloperidol
• Anticonvulsants: Valproic Acid, Phenytoin
  
• GI agents: Simethicone, metoclopramide, peppermint, antacids
• Gabapentin
• Baclofen
• Other: Nifedipine, midazolam, lidocaine, sertraline, dexamethasone

Medical procedures include:

• Surgery
• A nerve block or nerve stimulators

Alternative therapies include:

• Acupuncture
• Hypnosis
• Rectal Massage
• Sexual intercourse and ejaculation
  

Complications of Hiccups

Acute hiccups are usually harmless; however, chronic or intractable hiccups can lead to the following complications:

• Insomnia
• Unintentional weight loss
• Fatigue
• Depression
• Gastrointestinal issues
• Dehydration

Diagnosing the Cause of Hiccups

Having a thorough assessment by your healthcare provider is vital for diagnosing the cause of chronic or intractable hiccups. You can expect to undergo a physical exam, review of symptoms, and evaluate your current medications.

Based on these findings, your healthcare provider may order bloodwork and imaging tests (X-ray, CT scan, or MRI). You may also need a consult with a specialist such as a neurologist, gastroenterologist, or otolaryngologist.

When to See a Healthcare Provider

It's important to contact your healthcare provider for the following symptoms due to hiccups:

• Hiccups lasting more than 48 hours
• Unintentional weight loss
• Inability to eat or drink
• Insomnia
• Quality of life affected by hiccups

Summary

Hiccups are a result of involuntary spasms of the diaphragm. Acute hiccups usually last less than 48 hours. Eating too quickly, gulping soda, drinking alcohol, or overeating can cause acute hiccups. In rare cases, hiccups can be chronic or intractable, lasting days or months. Intractable hiccups can be a sign of a serious medical condition.

Several home remedies can cure acute hiccups. Intractable hiccups, however, may need to be treated with medical interventions. Contact your healthcare provider if you have hiccups that last more than 48 hours, have unintentional weight loss, can't eat or drink, and feel your quality of life is affected.