When are hiccups serious? | Ohio State Medical Center

Author:


J. Chad Hoyle, MD

Topics:

• Health and Wellness
• Neurological Institute

February 07, 2020

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.

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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.

How to beat hiccups? – BBC News Russian service

• Claudia Hammond
• BBC Future

4 November 2014

Image copyright, Thinkstock

Image caption,

Sticking out your tongue as much as possible often helps too

Holding your breath or trying something more exotic and rough? Correspondent
BBC Future talks about how to stop hiccups on your own and why these methods work.

As soon as someone starts hiccuping, everyone vies with each other to frighten the unfortunate person, suggest him to hold his breath and give a lot of other advice. What ways to beat hiccups are supported by scientific evidence?

Hiccups are a result of diaphragmatic spasm, causing air to flow into the lungs, which in turn causes a sharp closure of the vocal cords with a characteristic “hic” sound. There are more than a hundred causes of hiccups – in most cases quite harmless. For example, it may be related to taking medications – hiccups can provoke some anesthetics and steroid drugs, drugs prescribed for Parkinson’s disease, as well as chemotherapy drugs used to treat cancer. But, as a rule, this is not the case. Laughter, alcohol abuse, hasty swallowing of food or carbonated drinks can also lead to hiccups – and sometimes it even occurs on its own, without any reason.

Not without extremes. It is believed that the world record for the duration of hiccups belongs to an American named Charles Osborne: he had an attack of hiccups in 1922 (according to reports, at that moment he was trying to weigh a pig), and stopped only 68 years later – in February 1990.

Fortunately, hiccups can usually be stopped by simpler methods – although the debate over which of them is most effective has not subsided yet.

The bulk of folk remedies affect one of two mechanisms. The first group includes methods aimed at increasing the level of carbon dioxide in the blood, which is designed to relieve spasm of the diaphragm, such as holding the breath or breathing through a paper bag.

Sometimes these methods are effective, but scientists still do not really understand what they work. Some believe that this allows you to switch attention to the problem of increasing the concentration of carbon dioxide, while others suggest that it is the lack of this gas that is one of the causes of hiccups, so its replenishment allows you to stop the attack.

An alternative way to combat hiccups is to stimulate the vagus nerve, which connects the head to the abdomen and is responsible for coordinating breathing and swallowing. This nerve is involved in the process of hiccups, which can be interrupted by a certain impact on the nerve, as a result of which it begins to send signals to the brain about the appearance of a new sensation.

This group includes advice to drink water, chew on a lemon or fill your mouth with crushed ice. To stimulate the vagus nerve, you can also stick out your tongue, put your fingers in your ears, or apply light pressure on your eyeballs. In essence, this is an attempt to distract the body from hiccups by turning attention to some unexpected event. Attempts to stop hiccups by frightening the sufferer are based on the same logic.

Image credit: Thinkstock

Image caption:

There are also radical remedies for hiccups that are not suitable for home use. Or just the opposite?

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There is another radical remedy that is perhaps not suitable for home use. It was introduced by Francis Fesmire, a professor at the Faculty of Medicine at the University of Tennessee (USA). The essence of the method is clear from the title of his scientific work, published in 1988, – “Cessation of intractable hiccups by rectal massage. ”

It all started when a man came to the emergency room complaining of hiccups that lasted for three days at two second intervals. The doctor forced the patient to open his mouth wide, pressed his eyeballs, but nothing helped. After trying every means, Fesmire recalled reading last year about how a doctor managed to stop a fast heartbeat in a 71-year-old woman by inserting a finger into her anus. This remedy also helped the hiccuping patient.

However, having received a parody Ig Nobel Prize for his discovery, Fesmire stated that the same effect could most likely be achieved through orgasm, and most patients would certainly prefer this method. Both of these approaches also aim to stimulate the vagus nerve.

Most folk remedies for getting rid of hiccups really do not have scientific evidence. However, the mechanisms on which they are based are consistent with our knowledge of its physiology; in addition, all these methods are considered harmless. None of them is universal, which is why they are so numerous, but all of them are not just idle fiction. Start hiccuping – feel free to try any of them.

Disclaimer. All information in this article is provided for general information only and should not be taken as a substitute for the advice of your physician or other healthcare professional. The BBC is not responsible for the content of external sites linked to in this article and does not endorse any commercial product or service mentioned or recommended on any of these sites. In case of health problems, contact your physician immediately.

Read
the original of this article in English is available on the website
BBC Future .

Scientists figured out how to beat hiccups

A device to combat hiccups has been developed by an international group of scientists. A special drinking tube allows you to simultaneously stimulate the phrenic and vagus nerves, which are involved in hiccups, and with the help of this, stop the attack. Although the straw has shown its effectiveness, not all experts agree that there is a need for such an invention at all.

There are many traditional methods to get rid of hiccups, ranging from simple and popular – hold your breath, drink water – and ending with quite extravagant, such as rectal massage. However, there are no clinically confirmed among them.

Hiccups are caused by sudden contractions of the diaphragm and intercostal muscles. At the same time, the air is sharply drawn in between the vocal folds with a characteristic sound. Hiccups can occur if you swallow food too quickly, drink too much, or just get cold. Prolonged unreasonable hiccups can also be a symptom of various diseases, from encephalitis to heart attack and brain tumors, so if hiccups occur frequently and do not go away for a long time, you should consult a doctor.

Neurosurgeon Ali Seifi of the University of Texas wondered how to beat chronic hiccups while monitoring patients in the intensive care unit.

“Hiccups affect many patients with brain injuries, strokes, and patients undergoing cancer chemotherapy,” he says.

So, one of the patients began to hiccup after a brain operation, the nurses tried to help him with traditional methods, but this did not help much, and the patient only got more upset. A few days after that, Seifi himself experienced a bout of hiccups while speaking to students. At that moment, he decided that he needed to find a simple and effective solution.

Seifi and colleagues developed the HiccAway drinking device, a rigid L-shaped straw with a mouthpiece at one end and a pressure valve in the form of a small hole at the other.

When you have hiccups, you need to drink water through this tube – according to the idea of ​​the creators, the effort applied for drinking activates the phrenic nerve, and subsequent swallowing activates the vagus nerve. They are both associated with hiccups, and if both are affected at the same time, the hiccups should stop.

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“Hypothetically, when these two nerves are busy, they don’t have time to get confused and cause hiccups,” says Seifi.

To evaluate the effectiveness of the straw, the researchers recruited 249 volunteers who said they hiccupped at least once a month. It turned out that it allows you to stop hiccups in 92% of cases. More than 90% of the participants reported that the straw was more comfortable than traditional methods known to them, with most of them also adding that it gave better results. A detailed report was published in the journal Jama Network Open .

“The device works instantly and the effect lasts for several hours,” says Seifi.

However, the participants self-assessed their condition, and there was no control group in the study, so the results have yet to be cross-checked.

“Future studies will need to evaluate the efficacy of the tube in randomized clinical trials,” the researchers report. They note that such tests have already begun in the United States, Japan and Switzerland.

The device is likely to be useful and safe in terms of the risks of spreading COVID-19, says neurologist Rhys Thomas from Newcastle University. However, the need for a tube is questionable.

“I think this is a solution that no one asked for,” he said, adding that there are other effective and inexpensive options. He himself, for example, in case of hiccups, tightly plugs both ears and drinks a glass of water through an ordinary tube.

“Anything that allows you to expand your chest and swallow will work,” says Thomas.

Andrey Pichugin from Buryatia would hardly agree with Thomas – the man has been struggling with incessant hiccups for two years now. She does not allow him to eat and sleep normally, and recedes only during heavy physical exertion. Recently, he succeeded in obtaining admission to the N.N. Vishnevsky in Moscow. Pichugin hopes that they will help him at least here.

Previously cured of hiccups that lasted several years, was able to Briton Chris Sands.