Hiccups are caused by a sudden contraction of your diaphragm. The diaphragm is a muscle under your lungs that helps you breathe in. The top of your windpipe (your glottis) closes immediately after your diaphragm contracts which makes the typical ‘hic’ sound.
A hiccup is an automatic action of the body that you can’t control (a reflex). However, unlike other reflexes, such as coughing and sneezing, hiccups do not seem to have any useful purpose.
Who gets hiccups?
Hiccups are very common. They affect women and men equally, although persistent hiccups occur much more commonly in men. They happen mainly in the evening.
Short bouts of hiccups
Most people have bouts of hiccups from time to time. In most cases they start for no apparent reason, last a short while, then stop. Sometimes they are due to:
- Sudden excitement or emotional stress.
- A temporary swollen stomach caused by overeating or eating too fast, drinking fizzy drinks, or swallowing air.
- A sudden change in temperature (very hot or cold food or drinks, a cold shower, etc).
- Excess smoking.
Most cases need no treatment, as a bout of hiccups usually soon goes.
There are many popular remedies that are said to stop a short bout of hiccups but they are based on people’s individual experiences. It is not clear how effective they are, as they have not been tested by research trials. They include the following:
- First, block off all airways by putting fingers in your ears and blocking your nostrils. Then, take a sip or two of water from a glass. It is possible to do this alone (looks a bit silly – but is possible) but you may find it easier with an assistant.
- Sipping iced water.
- Swallowing granulated sugar.
- Biting on a lemon or tasting vinegar.
- Breath holding, breathing fast, or breathing into a paper bag.
- Gasping after a sudden fright, or sneezing.
- Pulling your knees up to your chest and/or leaning forward to compress the chest.
- Using a technique called the Valsalva manoeuvre. (The Valsalva manoeuvre means trying to push your breath out while you hold your throat and voice box closed.) The way to do this is to take a deep breath in, then keep the air inside you while pushing with your muscles as if to force the air out. This is like pushing in childbirth or straining on the toilet.
Persistent hiccups lasting for more than 48 hours
Persistent hiccups are rare.
- In some cases, persistent hiccups are caused by an underlying disease. Over 100 diseases have been reported to cause hiccups. Some are common, such as acid reflux and some are rare. You would normally have other symptoms apart from the hiccups.
- In some cases of persistent hiccups there is no apparent cause. However, the persistent hiccups can become exhausting and distressing.
Examples of conditions which can cause persistent hiccups are:
- Certain medicines – examples are steroids, tranquillisers, painkillers containing opiates (such as morphine) and methyldopa (for blood pressure).
- Changes in blood chemistry such as from alcohol, high blood sugar, or lack of calcium or potassium in the blood.
- Gut problems such as acid reflux, stretching (distention) of the stomach, infection of the gallbladder or infection under the diaphragm.
- A general anaesthetic.
- Conditions affecting the neck, chest or tummy (abdomen). For example, surgery, infections (such as sore throat or pneumonia), swellings or tumours in these parts of the body.
- Some heart conditions – a heart attack or inflammation around the heart.
- Brain conditions such as stroke, head injury or brain infection.
- Hiccups sometimes occur in the late stages of a terminal illness such as when a person is very ill with advanced cancer.
What is the treatment for persistent hiccups?
Firstly, try any of the popular remedies used to treat short bouts of hiccups (explained above). Also, treat any underlying cause, if possible.
Secondly, medication is sometimes needed to stop persistent hiccups. Various medicines have been used for this. The following medicines may be used for treating adults with hiccups (for children, specialist advice is recommended):
- Chlorpromazine or haloperidol are medicines which can relax the diaphragm muscle or its nerve supply and may stop persistent hiccups.
- For stomach problems such as acid reflux or a stretched (distended) stomach: anti-acid medicines (various types, such as omeprazole or ranitidine) or medicines which help the stomach to empty faster (such as metoclopramide).
- Baclofen – this a medicine which helps to relax muscles.
- Gabapentin – this can help to relax the nerve supply to the muscle under your lungs that helps you breathe in (the diaphragm).
- Ketamine – an intravenous anaesthetic – is sometimes effective when other treatments have failed.
- Giving a medication called metoclopramide by intravenous injection has been reported to cure hiccups occurring after anaesthetic.
- For people with a terminal illness, sedatives such as midazolam can help to control hiccups and relieve the stress they cause.
Referral to a specialist is often advised for persistent hiccups, either to look for a cause, or to offer more treatment options. Some examples of treatments that have been successfully used for persistent hiccups are:
- Acupuncture or hypnotherapy.
- A device similar to a pacemaker. This is used to stimulate or pace the nerve to the diaphragm (the phrenic nerve) or to stimulate another important nerve in the neck, called the vagus nerve.
For hiccups that continue despite treatment, a phrenic nerve block is occasionally used. This involves interrupting the phrenic nerve – for example, by injecting a local anaesthetic near the nerve. However, this treatment needs to be considered carefully: it carries risks because the phrenic nerve is important in breathing.