What are hiccups?
Hiccups are bursts of inspiratory (breathing in) activity. The muscles we use when we take in a breath are the intercostal muscles situated between the ribs, and the diaphragm – a sheet of muscle below the lungs.
Most simple cases of hiccups come after eating or drinking too much or too quickly. The stomach, which is situated right below the diaphragm, becomes distended and irritates it. This will cause the diaphragm to contract, as it does when we breathe in.
Why do hiccups occur?
Sometimes hiccups will occur because of a disturbance to the nerve pathways from the brain to the muscles involved. This explains why hiccups may occur with temperature changes or emotional situations. It is also the reason that a sudden shock can sometimes abolish an attack.
Persistent hiccups may signify problems in the brain, spinal cord or any of the structures around the diaphragm or chest wall.
Everyone has their own pet remedy for curing hiccups. Simply holding your breath is often effective. Breathing into a paper bag, the best remedy, increases the amount of carbon dioxide in the lungs, relaxing the diaphragm and halting the spasms.
Causes of hiccups
Experts have yet to reach a definitive conclusion on what the mechanisms are that cause hiccups, or why they occur. According to studies, the following circumstances, conditions and illnesses have been associated with a higher risk of developing hiccups:
- Hot food has irritated the phrenic nerve. The phrenic nerve is near the esophagus.
- When there is gas in the stomach, which presses against the diaphragm.
- Too much food is eaten.
- Food is eaten too rapidly.
- There is a sudden change in temperature.
- Fizzy drinks are consumed.
- Some people get hiccups after eating spicy foods.
- After eating dry breads.
- Many people anecdotally report hiccups after consuming alcoholic beverages.
- Some medications, such as opiates, benzodiazepines, anesthesia, corticosteroids, barbiturates, and mythyldopa are known to cause hiccups.
Some medical conditions are linked to a higher incidence of hiccups, such as:
- Gastrointestinal conditions, including IBD (inflammatory bowel disease), a small bowel obstruction, or GERD (gastro-esophageal reflux disease).
- Respiratory conditions, such as pleurisy, pneumonia or asthma.
- Conditions which affect the CNS (central nervous system), including a traumatic brain injury, encephalitis, a brain tumor, or stroke.
- Conditions which irritate the vagus nerve, such as meningitis, pharyngitis or goitre.
- Psychological reactions, including grief, excitement, anxiety, stress, hysterical behavior, or shock.
- Conditions which affect metabolism, including hyperglycemia, hypoglycemia, or diabetes.
Often, hiccups occur unexpectedly and neither the patient nor the doctor can identify their likely cause.
Possible complications of hiccups
If a patient has prolonged hiccups, complications may develop, including:
- Weight loss – in some cases the hiccups are not only long-term, but occur at short intervals, making it hard for the patient to eat properly.
- Insomnia – if the prolonged hiccups persist during the sleeping hours, the patient will find it hard to get to sleep, and/or stay asleep.
- Fatigue – people with prolonged hiccups may become exhausted, especially if they cannot sleep or eat properly.
- Communication problems – persistent hiccups may make it harder for the patient to communicate orally.
- Depression – patients with long-term hiccups have a considerably higher risk of developing clinical depression.
- Post-surgical wound healing – if the patient is hiccupping all day long, post-surgical wounds will probably take much longer to heal. Some patients may have a higher risk of developing infections, or start bleeding after surgery.
Tests for patients with prolonged hiccups
Hiccups that last less than 48 hours do not usually need any medical attention, because they resolve on their own. If the hiccups persists for longer, a doctor should be consulted. Incredibly, Charles Osborne had the hiccups for 68 years, from 1922 to 1990, but this is a rare case.
After talking to the patient about their hiccups, when they began, how often they occur, etc., the doctor will probably perform a general physical exam and then a neurological exam to check the person’s:
- Sense of touch
- Muscle strength
- Muscle tone.
If the doctor, at this point, believes an underlying condition may be the cause, the following diagnostic tests may be ordered:
- Blood tests – to check for infection, kidney disease or diabetes
- Imaging tests – to determine whether there are any anatomical abnormalities which may be affecting the phrenic or vagus nerves or the diaphragm. This may involve taking a chest X-ray, a CT scan or an MRI scan.
- Endoscopic test – the doctor inserts an endoscope, a flexible tube with a small camera at the end, down the patient’s throat to check the windpipe or esophagus.
- An electrocardiogram (ECG) – this test checks for heart-related conditions by measuring electrical activity in the heart.
Hiccups treatment and possible cures
Below are some tips and home remedies for dealing with a bout of hiccups. All of these are ideas recommended by the NHS and CDC:
Breathing and posture
- Breathe in and hold the breath for about 10 seconds, then breathe out slowly. Repeat three or four times. Then repeat 20 minutes later.
- Breathe into a paper bag – it is important to not cover the head with the bag.
- Bring the knees to the chest and hug them for 2 minutes.
- Gently compress the chest; this can be achieved by leaning forward.
Eating and drinking
- Gargle with iced water.
- Drink from the far side of the glass – stand up, bend over, and place the mouth on the opposite side of the glass. While bending, tilt the glass away from the body and drink.
- Place a couple of drops of vinegar in the mouth.
- Place some granulated sugar on the tongue. When it melts, swallow it.
- Sip very cold water slowly.
- Drink a glass of warm water very slowly, all the way down without breathing.
- Take a thin slice of lemon, place it on the tongue and suck it like a sweet.
- Burping – some people find that if they consume a fizzy drink and burp, their hiccups go away. However, some doctors warn that sodas may also trigger hiccups.
- Pull on the tongue – hold the end of the tongue in the fingers and tug. This stimulates the vagus nerve and eases diaphragm spasms, which may sometimes stop hiccups. This often does not work.
- Press on the diaphragm gently.
- Place gentle pressure on each side of the nose while swallowing.
In the vast majority of cases, hiccups go away on their own. Some say that by simply waiting and not worrying about them, the problem is likely to resolve more quickly.
If hiccups are caused by an underlying condition, treating that condition may help get rid of them.
Are there any medications for hiccups?
If hiccups are persistent, a doctor may prescribe medication. This is often the case if a patient is:
- unable to eat properly and is losing weight
- sleeping abnormally or has insomnia
- displaying signs and symptoms of clinical depression
The following drugs are known to help people with persistent hiccups:
- Baclofen – a muscle relaxant.
- Chlorpromazine – an antipsychotic medication.
- Gabapentin – initially used for treating epilepsy, it is now prescribed for neuropathic pain and hiccups.
- Haloperidol – an antipsychotic medication.
- Metoclopramide (Reglan) – a medication used in the treatment of nausea.
Generally, doctors will reserve medication as a final resort having tried other options. Medications will also only be prescribed for severe and longer-term hiccups.
Certain triggers cause most cases of hiccups. Avoiding these triggers can reduce the risk of hiccups occurring; these triggers include:
- eating or drinking too quickly
- drinking alcohol
- eating spicy foods
- a sudden change of temperature in the stomach caused by eating or drinking
- extreme emotions
- swallowing air while chewing gum
If hiccups are caused by an underlying medical condition, such as Gastroesophageal Reflux Disease (GERD), treating that condition can prevent them.
Credits: (1) Medical News Today
(2) University of Illinois-Chicago, School of Medicine