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On and off hiccups. Understanding Hiccups: Causes, Remedies, and When to Seek Medical Attention

by alexxlab

What causes hiccups and how can they be treated. When do hiccups become a serious medical concern. What are effective home remedies for stopping hiccups. How do hiccups relate to the nervous system. When should you see a doctor about persistent hiccups.

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The Physiology of Hiccups: What’s Really Happening in Your Body

Hiccups are a common physiological phenomenon that most people experience from time to time. But what exactly is happening in your body when you hiccup? Hiccups occur when your diaphragm, the muscle separating your chest cavity from your abdomen, suddenly contracts. This contraction causes a quick intake of air, which is then abruptly stopped by the closure of your vocal cords, producing the characteristic “hic” sound.

The spasm that causes a hiccup originates in your diaphragm or the nerves controlling it, primarily the phrenic and vagus nerves. These nerves are part of your autonomic nervous system, which regulates involuntary bodily functions like heart rate and breathing.

Common Triggers for Hiccups

  • Eating too quickly or consuming large portions
  • Drinking carbonated beverages or alcohol
  • Swallowing air while chewing gum or eating candy
  • Sudden temperature changes
  • Emotional states like excitement, nervousness, or stress
  • Esophageal irritation or reflux

Home Remedies: Effective Ways to Stop Hiccups

While hiccups often resolve on their own, there are several home remedies that many people find effective. These methods typically work by either disrupting your breathing pattern or stimulating the vagus nerve to “reset” the diaphragm spasms.

Popular Hiccup Remedies

  1. Holding your breath briefly
  2. Performing the Valsalva maneuver (attempting to exhale while closing your mouth and pinching your nose)
  3. Drinking a glass of water quickly
  4. Eating a spoonful of sugar or peanut butter
  5. Sucking on a lemon wedge
  6. Applying mild pressure to closed eyes
  7. Ingesting ice chips

Why do these remedies work? Many of these techniques stimulate the vagus nerve, triggering what’s known as a vagal nerve response. This response can interrupt the cycle of hiccups by essentially “rebooting” the nervous system signals controlling the diaphragm.

When Hiccups Become a Concern: Duration and Associated Symptoms

While most cases of hiccups are benign and short-lived, there are instances when they may indicate a more serious underlying condition. How can you determine when hiccups warrant medical attention?

Duration as a Factor

Persistent hiccups that last for more than a couple of days should be evaluated by a healthcare provider. This is especially important if the hiccups are interfering with your sleep or daily activities. Prolonged hiccups can sometimes be a sign of an underlying medical condition or a side effect of certain medications.

Associated Symptoms to Watch For

More critical than duration are any additional symptoms that occur alongside the onset of hiccups. If you experience any of the following symptoms in conjunction with hiccups, seek immediate medical attention:

  • Sudden numbness or coordination issues
  • Difficulty speaking or swallowing
  • Facial drooping
  • Changes in speech
  • Vision changes, particularly loss of partial vision
  • Weakness on one side of the body
  • Any cardiovascular symptoms

These symptoms could indicate a serious condition such as a stroke, which requires immediate medical intervention.

The Neurological Connection: How Hiccups Relate to Brain and Nerve Function

Hiccups, while seemingly simple, have a complex neurological basis. The involvement of the phrenic and vagus nerves in the hiccup reflex highlights the intricate connection between our nervous system and this common bodily function.

Neurological Causes of Persistent Hiccups

In rare cases, persistent hiccups can be associated with neurological disorders. What conditions might lead to prolonged hiccupping episodes?

  • Brain tumors
  • Strokes
  • Multiple sclerosis
  • Encephalitis
  • Traumatic brain injury

These conditions can affect the areas of the brain responsible for controlling the hiccup reflex or irritate the nerves involved in the process. While uncommon, understanding this connection emphasizes the importance of seeking medical attention for unusually persistent hiccups.

Hiccups and Digestive Health: The Gastrointestinal Connection

While many associate hiccups primarily with the respiratory system, there’s a significant link between hiccups and digestive health. How does our gastrointestinal system influence the occurrence of hiccups?

Gastroesophageal Reflux and Hiccups

One of the most common digestive issues linked to hiccups is gastroesophageal reflux disease (GERD). When stomach acid flows back into the esophagus, it can irritate the phrenic nerve, potentially triggering hiccups. This connection explains why people with chronic acid reflux may experience more frequent bouts of hiccups.

Other Digestive Triggers

  • Overeating or eating too quickly
  • Consuming spicy foods
  • Swallowing air while eating
  • Stomach distension

Understanding these triggers can help individuals manage their hiccups by making dietary and eating habit adjustments. For those experiencing frequent hiccups, keeping a food diary to identify potential triggers may be beneficial.

Medications and Hiccups: Both Cause and Cure

Medications play a dual role in the world of hiccups – they can both cause and treat this peculiar bodily function. How do various medications interact with our body’s hiccup mechanism?

Medications That May Cause Hiccups

Certain medications have been associated with an increased likelihood of experiencing hiccups. These include:

  • Steroids
  • Benzodiazepines
  • Barbiturates
  • Some chemotherapy drugs

If you’re experiencing persistent hiccups and are on any of these medications, it’s important to consult with your healthcare provider. They may be able to adjust your medication regimen to alleviate this side effect.

Medications Used to Treat Persistent Hiccups

For cases of prolonged hiccups that don’t respond to home remedies, doctors may prescribe certain medications. What are some of the drugs used to treat persistent hiccups?

  • Baclofen: A muscle relaxant that can help reduce diaphragm spasms
  • Chlorpromazine: An antipsychotic medication that can also suppress hiccups
  • Metoclopramide: A drug that increases muscle contractions in the upper digestive tract, which may help stop hiccups
  • Gabapentin: An anti-epileptic drug that has shown effectiveness in some cases of intractable hiccups

It’s crucial to note that these medications should only be used under the guidance of a healthcare professional, as they can have side effects and may interact with other medications.

Hiccups in Special Populations: Children, Elderly, and Pregnant Women

While hiccups are a universal experience, they can manifest differently or have varying implications in certain populations. How do hiccups affect children, the elderly, and pregnant women?

Hiccups in Children

Hiccups are particularly common in infants and young children. In fact, even fetuses have been observed hiccupping in the womb! For most children, hiccups are harmless and often resolve on their own. However, persistent hiccups in children, especially if accompanied by other symptoms, should be evaluated by a pediatrician.

Hiccups in the Elderly

In older adults, persistent hiccups may be more likely to signal an underlying health issue. The elderly are more prone to conditions that can cause hiccups, such as GERD or certain neurological disorders. Additionally, older adults may be taking medications that increase the likelihood of hiccups.

Hiccups During Pregnancy

Pregnant women often experience an increase in hiccups, particularly in the later stages of pregnancy. This is typically due to the growing uterus putting pressure on the diaphragm. While usually harmless, persistent hiccups during pregnancy should be mentioned to a healthcare provider, especially if they interfere with eating or sleeping.

The Psychology of Hiccups: Stress, Anxiety, and Psychogenic Factors

While hiccups are primarily a physiological phenomenon, psychological factors can play a significant role in their occurrence and persistence. How do stress, anxiety, and other psychological states influence hiccups?

Stress-Induced Hiccups

Stress and anxiety can trigger hiccups in several ways. When we’re stressed, we may:

  • Breathe more rapidly or irregularly, potentially leading to air swallowing
  • Experience increased muscle tension, including in the diaphragm
  • Have heightened nervous system activity, which can affect the nerves controlling the hiccup reflex

For some individuals, hiccups may even become a conditioned response to stress, occurring more frequently in anxiety-provoking situations.

Psychogenic Hiccups

In rare cases, persistent hiccups may have a psychological origin, a condition known as psychogenic hiccups. These hiccups are not caused by any physical condition but are instead related to psychological factors. They may be associated with:

  • Conversion disorder
  • Malingering
  • Certain personality disorders

Diagnosis of psychogenic hiccups is typically made after ruling out all potential physical causes. Treatment often involves a combination of psychological interventions and relaxation techniques.

The Mind-Body Connection in Hiccup Management

Understanding the psychological aspects of hiccups can be beneficial in their management. Stress-reduction techniques such as deep breathing exercises, meditation, or progressive muscle relaxation may help prevent or alleviate stress-induced hiccups. For individuals with frequent hiccups, addressing underlying anxiety or stress through therapy or counseling could potentially reduce their occurrence.

It’s important to note that while psychological factors can contribute to hiccups, most cases are indeed physiological in nature. However, recognizing the mind-body connection can provide additional tools for managing this common yet sometimes perplexing bodily function.

When are hiccups serious? | Ohio State Medical Center


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Hiccups. They can be annoying or embarrassing, but we typically don’t think of them as concerning. They’re usually short-lived, although in rare cases, they can persist. When they last more than a of couple days, or if other symptoms occur at their onset, they can be a sign of a more serious medical condition.

What causes hiccups?

Hiccups seem to come from the chest–a quick influx of air that hits your vocal cords and causes a little sound. The spasm that causes a hiccup is really coming from your diaphragm or the nerves that control it. Some common causes include:

  • Eating too much or too fast
  • Feeling excited, nervous or scared
  • Drinking carbonated beverages or too much alcohol (sometimes in excess)
  • Stress
  • A sudden change in temperature
  • Swallowing air while chewing gum or sucking on candy
  • Irritation of the esophagus

Esophageal reflux is a common cause of hiccups. Prolonged hiccups, though, could be caused by direct post-surgical irritation of the phrenic or vagus nerves. Irritation can also be caused by cancers of the chest or neck. Rarely, hiccups can be associated with disorders of the brain–including tumors and strokes, among others—or cardiovascular disease. Some medications can trigger long-term hiccups, too.

Finally, hiccups can also persist without an apparent cause.

What really gets rid of hiccups?

Before we worry too much about serious conditions, let’s consider some of the many recommendations to get rid of your hiccups. One of the most common is temporarily holding your breath to disrupt your breathing pattern. It can be helpful, and it doesn’t carry much risk to try.

As mentioned, the vagus and phrenic nerves affect your diaphragm. They’re part of your autonomic nervous system, which controls your heart rate and breathing.

Maneuvers that affect the nerve reflex may knock out your hiccups. The Valsalva maneuver is performed by attempting to exhale while closing your mouth and pinching your nose shut at the same time. You’ll bear down a bit as well, trying to (unsuccessfully) expel air, as if blowing up a balloon.

This motion stimulates the vagus nerve, called a vagal nerve response, and it can interrupt the hiccups. I like to think of it as rebooting your nervous system; sort of a reset for the irritated nerves.

Ingesting ice or applying mild pressure to your closed eye might also reboot this nervous system response.

You also may get rid of hiccups with a spoonful of sugar to stimulate the back of your throat (which also might cause a vagal nerve response). Eating peanut butter from a spoon might relax the back of your throat and could help. Interestingly, some patients have had success getting rid of hiccups by eating a lemon wedge.

The one common recommendation to be cautioned against is the tradition of scaring someone to rid them of hiccups. While the gasp of fright may induce a vagal nerve response that interrupts the spasm, it also risks dangerous side effects: If you scare someone, they could lose their balance and fall, and being startled may also negatively impact an underlying heart condition.

When should you seek medical attention?

There are two scenarios that should send you for medical care. First, if hiccups persist more than a couple of days, you should seek care with your primary care provider. This is important especially if the hiccups are preventing you from sleeping. Your provider can rule out other medical causes and may prescribe medications if more traditional methods of stopping your hiccups aren’t working.

More important than the duration, though, is the onset of additional symptoms with the hiccups. You may need to seek emergency care if your hiccups are accompanied by symptoms such as the sudden onset of numbness or coordination issues. These could indicate a stroke, which is serious and needs immediate treatment. Other symptoms of stroke include the sudden onset of difficulty speaking or swallowing, facial droop, speech change, vision changes (losing part of your vision) or weakness on one side of your body.

Pay attention to your body. If the onset of hiccups includes any cardiovascular symptoms, go to an emergency department and get evaluated right away.

But if you’re not experiencing anything else, give it a couple of days. Transient hiccups are usually part of the normal spectrum of life.

 

J. Chad Hoyle is a neurologist specializing in neuromuscular disorders and electromyography at The Ohio State University Wexner Medical Center.

Visit Ohio State Health & Discovery for more stories on health, wellness, innovation, research and science news from the experts at Ohio State.

Check out health.osu.edu


How to Make Them Stop and More

Hiccups are caused by the diaphragm involuntarily contracting. Some common causes for this contraction include drinking carbonated beverages, eating a large meal, swallowing too much air, or stress.

Hiccups are repetitive, uncontrollable contractions of the diaphragm, the muscle structure just below your lungs.

The diaphragm marks the boundary between your chest and abdomen, and it also regulates breathing. When your diaphragm contracts, your lungs take in oxygen. When your diaphragm relaxes, your lungs release carbon dioxide.

The diaphragm contracting out of rhythm is what causes hiccups. Each spasm of the diaphragm makes the larynx (voice box) and vocal cords close suddenly. This results in a sudden rush of air into the lungs. Your body reacts with a gasp or chirp, creating the sound characteristic of hiccups.

There’s no way to anticipate hiccups. With each spasm, there’s usually a slight tightening of the chest or throat prior to you making the distinctive hiccup sound.

Most cases of hiccups start and end abruptly, for no noticeable reason. Episodes generally last only a few minutes.

Did you know?

The medical term for hiccups is singultus.

Numerous causes of hiccups have been identified. However, there’s no definitive list of triggers. Hiccups often come and go for no apparent reason.

Common causes of short-term hiccups may include:

  • overeating
  • eating spicy food
  • consuming alcohol
  • drinking carbonated beverages, like sodas
  • consuming very hot or very cold foods
  • a sudden change in air temperature
  • aerophagia, which is swallowing too much air
  • swallowing air while chewing gum
  • excitement or emotional stress

There are several factors that can increase your likelihood of developing hiccups. You may be more susceptible if you:

  • are male
  • experience intense mental or emotional responses, ranging from anxiety to excitement
  • have had surgery, especially abdominal surgery
  • have received general anesthesia

Hiccups and your baby

Hiccups can occur at any age. They can even occur while a fetus is still in the womb.

Hiccups are also normal in newborns, are rarely bothersome for them, and don’t typically require home remedies or treatment.

Was this helpful?

Most hiccups aren’t an emergency or anything to worry about. However, a prolonged episode can be uncomfortable and disruptive to your daily life.

Contact a doctor if you have hiccups that last longer than 2 days. The doctor can determine the severity of your hiccups in relation to your overall health and other conditions.

There are numerous options for treating hiccups. Typically, a short-term case of hiccups will take care of itself. However, the discomfort may make waiting out hiccups unbearable if they last longer than a few minutes.

Home remedies

Not all of these have been proven to stop hiccups, but you can try the following potential treatments for hiccups at home:

  • Breathe into a paper bag.
  • Eat a teaspoon of granulated sugar.
  • Hold your breath.
  • Drink a glass of cold water.
  • Pull on your tongue.
  • Lift your uvula, which is the fleshy piece of tissue that’s suspended above the back of your throat, with a spoon.
  • Attempt to purposefully gasp or belch.
  • Bring your knees to your chest and maintain this position.
  • Try the Valsalva maneuver by shutting your mouth and nose and exhaling forcibly.
  • Relax and breathe in a slow, controlled manner.

Medications

Treating any underlying causes of your hiccups will usually make them go away.

If your hiccups last for a while and have no obvious cause, a doctor may recommend several anti-hiccup medications. The more commonly used medications include:

  • antipsychotic medications chlorpromazine and haloperidol
  • benzodiazepines, a class of tranquilizers
  • seizure medications, such as gabapentin (Neurontin)
  • diphenhydramine (Benadryl), an antihistamine
  • metoclopramide (Reglan), an anti-nausea drug
  • baclofen, a muscle relaxant
  • nifedipine (Procardia, Procardia XL), a blood pressure medication

The Food and Drug Administration (FDA) hasn’t approved any prescription medications for the treatment of hiccups. If a doctor recommends any of the prescription medications above, it’ll be an example of off-label drug use.

Off-label drug use

Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use them to treat their patients. So your doctor can prescribe a medication however they think is best for your care.

Massage

A doctor may perform a carotid sinus massage to help stop long lasting hiccups. This involves rubbing the main carotid artery in the neck.

Invasive procedures

There are also more invasive options, which can be used to end extreme cases of hiccups. They include:

  • nasogastric intubation, which is the insertion of a tube through your nose into your stomach
  • gastric lavage (stomach pumping)
  • an anesthetic injection to block the phrenic nerve, which is located in the diaphragm
  • surgical implantation of a diaphragmatic pacemaker, a battery-powered device that stimulates your diaphragm and regulates breathing

Hiccups that last longer than 48 hours are considered persistent. Hiccups that last longer than 2 months are considered intractable, or difficult to manage.

These types of long-term hiccups are categorized by the type of irritant that caused the episode.

Nerve injury or irritation

The majority of persistent hiccups are caused by injury or irritation to either the vagus or phrenic nerve. The vagus and phrenic nerves control the movement of your diaphragm. These nerves may be affected by:

  • irritation of your eardrum, which may be caused by a foreign object
  • throat irritation or soreness
  • goiter
  • gastroesophageal reflux disease (GERD)
  • an esophageal cyst or tumor

Central nervous system (CNS) damage

Other causes of hiccups may involve the central nervous system (CNS). The CNS consists of the brain and spinal cord. If the CNS is damaged, your body may lose the ability to control hiccups.

CNS damage that may lead to persistent hiccups includes:

  • stroke
  • multiple sclerosis (MS)
  • tumors
  • head trauma or brain injury
  • meningitis and encephalitis, which are infections that can cause swelling in the brain
  • hydrocephalus, or the accumulation of fluid on the brain
  • neurosyphilis and other brain infections

Other causes

Hiccups that last for longer periods can also be caused by:

  • misuse of alcohol
  • tobacco use
  • a reaction to anesthesia after surgery
  • certain classes of medications, including barbiturates, steroids, and tranquilizers
  • electrolyte imbalance
  • diabetes
  • kidney failure
  • arteriovenous malformation, a condition in which arteries and veins are tangled in the brain
  • Parkinson’s disease
  • cancer and chemotherapy treatments

Medical procedures

Sometimes, a medical procedure can accidentally cause you to develop long-term hiccups. These procedures are used to treat or diagnose other conditions and include:

  • use of catheters to access the heart muscle
  • placement of an esophageal stent to prop open the esophagus
  • bronchoscopy, in which a doctor uses a thin, lighted tube with a camera on the end to examine your lungs and airways
  • tracheostomy, or the creation of a surgical opening in the neck to allow breathing around an airway obstruction

Diagnosis

If the cause of your hiccups is unclear, a doctor may recommend tests. These can help detect any underlying disease or condition.

The following tests may be useful in determining the cause of persistent or intractable hiccups:

  • blood tests to identify signs of infection, diabetes, or kidney disease
  • liver function tests
  • imaging of the diaphragm with a chest X-ray, CT scan, or MRI
  • echocardiogram to assess heart function
  • endoscopy, in which a doctor uses a thin, lighted tube with a camera on the end to investigate your esophagus, windpipe, stomach, and intestine
  • bronchoscopy

A long-term episode of hiccups can be uncomfortable and even harmful to your health. If left untreated, prolonged hiccups can disturb your sleeping and eating patterns, leading to:

  • sleeplessness
  • exhaustion
  • malnutrition
  • weight loss
  • dehydration

There’s no proven method for preventing hiccups. However, if you experience hiccups frequently, you can try to reduce your exposure to known triggers.

Following this advice may also help reduce your susceptibility to hiccups:

  • Try not to overeat.
  • Avoid carbonated beverages.
  • Protect yourself from sudden temperature changes.
  • Don’t drink alcohol.
  • Remain calm, and try to avoid intense emotional or physical reactions.

Hiccups have a wide range of possible triggers, from drinking soda and eating certain foods to medication use and underlying conditions. A number of possible treatments are also available.

In rare instances, hiccups can last longer than 48 hours. If your hiccups last longer than 48 hours, don’t respond to treatment, or you aren’t sure what’s causing them, see a doctor for a diagnosis.

Also, see a doctor or seek emergency help if you’re having numbness and coordination issues alongside your persistent hiccups. These may be symptoms of a stroke.

Causes and Quick Remedies

Hiccups: Causes and Quick Remedies

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  • Hiccups: Causes and Quick Remedies

Hiccuping is an uncontrolled physiological reaction, in the development of which the phrenic nerve, vagus nerve, and centers of the brain are involved. During hiccups, the intercostal and diaphragmatic muscles tighten, as when inhaling, but the airways overlap, so there is a short breath hold. People hiccup with a characteristic sound, which is caused by the sharp closing of the vocal folds.

Why hiccups occur

Hiccups help to remove excess air from the stomach, so its periodic appearance is not considered a problem. It can occur with a hasty meal, talking while eating. Also, the symptom occurs during laughter, accompanied by a series of quick breaths and overflow of the stomach with air.

The second physiological reason for the appearance of hiccups is irritation of the fibers of the phrenic and vagus nerves, which triggers a specific reflex. The situation most often occurs when the stomach is overdistended with a large amount of food, when swallowing large pieces that hardly pass through the esophagus, after taking spicy, too hot or cold food. In some people, hiccups are provoked by hypothermia, stress, and drinking alcohol.

Long-term hiccups that occur frequently and without association with typical precipitating factors usually indicate a health problem. Possible causes of an unpleasant symptom:

● gastroesophageal reflux disease (GERD), diaphragmatic hernia and other diseases of the esophagus;

● diseases of the liver, pancreas, stomach and intestines;

● diseases of the chest organs – pleurisy, pneumonia, pericarditis, myocardial infarction;

● pathology of the nervous system: encephalitis, intracranial hypertension, traumatic brain injury, tumors of the posterior cranial fossa.

How to deal with hiccups

There are quite a few ways to quickly eliminate hiccups:

● breath holding for 20-30 s;

● a series of deep and slow breaths;

● drinking several sips of water;

● torso tilt forward;

● sucking on an ice cube;

● eating a piece of lemon or other product with a sharp taste;

● inhalation of ammonia;

● pulling the tongue forward for a few seconds.

These simple actions have one of two goals: to stimulate the vagus nerve to stop pathological impulses, or to increase the concentration of carbon dioxide in the blood, as a result of which the nervous regulation of the respiratory system normalizes. Usually a person needs to try several methods and choose the most suitable for himself.

Short-term hiccups pass without a trace and do not have a negative effect on the body, so it is not at all necessary to use the above methods. The person may simply wait a few minutes for the symptom to subside and then return to daily activities.

When to see a doctor

Hiccups that last for several hours and do not disappear after all the methods described in the previous section may be one of the first signs of an organic disease. In such a situation, patients are advised to visit a doctor in order to exclude or confirm the presence of a pathology, to start treatment on time.

The initial consultation is conducted by an ID-Clinic therapist who receives patients at the clinic and provides online consultations via video link. The doctor will analyze the symptoms, ask clarifying questions, refer you for an extended examination and consultation of highly specialized specialists, if necessary.

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