What triggers persistent hiccups. How to effectively stop hiccups at home. When do hiccups indicate a serious medical condition. What are the best remedies for chronic hiccups. How to distinguish between benign and concerning hiccup episodes.

Understanding the Mechanism of Hiccups

Hiccups are a common physiological occurrence that most people experience from time to time. But what exactly happens in our body when we hiccup? Hiccups originate from the diaphragm or the nerves controlling it, rather than the chest as commonly believed. The characteristic sound we associate with hiccups is produced when a sudden influx of air hits the vocal cords, resulting from a spasm in the diaphragm.

The Role of the Vagus and Phrenic Nerves

Two key nerves play a crucial role in the hiccup mechanism: the vagus and phrenic nerves. These nerves are part of the autonomic nervous system, which regulates involuntary bodily functions like heart rate and breathing. When these nerves are irritated or stimulated, it can lead to the spasmodic contractions of the diaphragm that we recognize as hiccups.

Common Triggers for Hiccups

While hiccups can seem to occur randomly, there are several common triggers that can increase the likelihood of experiencing them:

• Eating too much or too quickly
• Experiencing strong emotions such as excitement, nervousness, or fear
• Consuming carbonated beverages or excessive alcohol
• Experiencing stress
• Sudden temperature changes
• Swallowing air while chewing gum or eating candy
• Irritation of the esophagus, often due to acid reflux

Understanding these triggers can help individuals identify and potentially avoid situations that may lead to hiccups.

Effective Home Remedies for Hiccups

When hiccups strike, there are several home remedies that people often turn to for relief. While not scientifically proven, many individuals find these methods helpful:

1. Holding your breath: This technique aims to disrupt your breathing pattern and potentially stop the hiccup reflex.
2. The Valsalva maneuver: This involves attempting to exhale while keeping your mouth closed and pinching your nose shut. This action stimulates the vagus nerve and may interrupt the hiccup cycle.
3. Consuming a spoonful of sugar: The granules may stimulate the back of the throat, potentially triggering a vagal nerve response.
4. Eating peanut butter: The thick consistency may help relax the back of the throat and alleviate hiccups.
5. Sucking on a lemon wedge: Some individuals report success with this sour remedy.
6. Applying mild pressure to closed eyes: This may help “reboot” the nervous system response.
7. Ingesting ice: The cold sensation may stimulate the vagus nerve and interrupt the hiccup reflex.

It’s important to note that while these remedies are generally safe, individuals should avoid potentially dangerous methods such as intentionally scaring someone to stop their hiccups.

When Hiccups Become a Concern

While most hiccup episodes are benign and self-limiting, there are circumstances when they may indicate a more serious underlying condition. Persistent or chronic hiccups, defined as those lasting more than 48 hours, warrant medical attention. Additionally, the onset of hiccups accompanied by other symptoms may signal a need for immediate medical evaluation.

Red Flags to Watch For

If hiccups are accompanied by any of the following symptoms, it’s crucial to seek emergency medical care:

• Sudden onset of numbness
• Coordination issues
• Difficulty speaking or swallowing
• Facial droop
• Speech changes
• Vision changes, particularly loss of part of the visual field
• Weakness on one side of the body

These symptoms could indicate a stroke or other serious neurological conditions that require immediate medical intervention.

Underlying Medical Conditions Associated with Persistent Hiccups

While most hiccup episodes are harmless, prolonged or recurrent hiccups can sometimes be a symptom of an underlying medical condition. Some potential causes include:

• Gastrointestinal disorders: Conditions such as gastroesophageal reflux disease (GERD) or esophageal inflammation can trigger persistent hiccups.
• Neurological disorders: Brain tumors, strokes, or multiple sclerosis can sometimes manifest with chronic hiccups.
• Cardiovascular diseases: Certain heart conditions may present with hiccups as a symptom.
• Thoracic or neck cancers: Tumors in these areas can irritate the nerves responsible for hiccups.
• Metabolic imbalances: Conditions like diabetes or kidney disease can sometimes lead to persistent hiccups.
• Medication side effects: Certain drugs, particularly those affecting the central nervous system, may cause hiccups as a side effect.

Given the potential for serious underlying causes, it’s important to consult a healthcare provider if hiccups persist for an extended period or recur frequently.

Medical Interventions for Chronic Hiccups

When home remedies fail to provide relief for persistent hiccups, medical interventions may be necessary. Healthcare providers have several options at their disposal to treat chronic hiccups:

Pharmacological Treatments

Several medications have shown efficacy in treating persistent hiccups:

• Baclofen: This muscle relaxant can help reduce diaphragm contractions.
• Chlorpromazine: An antipsychotic medication that can also help control hiccups.
• Metoclopramide: This drug, typically used for nausea, can also be effective for hiccups.
• Gabapentin: An anticonvulsant that may help regulate nerve impulses causing hiccups.

Non-Pharmacological Interventions

In some cases, more invasive treatments may be considered:

• Nerve blocks: Injecting anesthetic around the phrenic nerve can sometimes stop persistent hiccups.
• Acupuncture: Some studies suggest acupuncture may be effective for chronic hiccups.
• Surgical interventions: In rare, severe cases, surgical procedures to interrupt the nerve pathways responsible for hiccups may be considered.

The choice of treatment depends on the underlying cause of the hiccups, the severity of the symptoms, and the individual patient’s overall health status.

Preventing Hiccups: Lifestyle Modifications

While it’s not always possible to prevent hiccups, certain lifestyle modifications may help reduce their frequency:

• Eat slowly and mindfully: Taking smaller bites and chewing food thoroughly can help prevent swallowing excess air.
• Avoid carbonated beverages: The bubbles in these drinks can lead to increased air in the stomach, potentially triggering hiccups.
• Limit alcohol consumption: Excessive alcohol intake is a known trigger for hiccups.
• Manage stress: Since stress can contribute to hiccups, practicing relaxation techniques may be beneficial.
• Maintain good posture: Proper posture, especially while eating, can help reduce the likelihood of hiccups.
• Stay hydrated: Drinking water regularly throughout the day may help prevent hiccups.
• Avoid sudden temperature changes: When possible, try to acclimate gradually to temperature changes, as sudden shifts can trigger hiccups.

By incorporating these habits into daily life, individuals may be able to reduce the frequency of hiccup episodes.

The Impact of Chronic Hiccups on Quality of Life

While occasional hiccups are typically more of a nuisance than a serious problem, chronic hiccups can significantly impact an individual’s quality of life. Persistent hiccups can lead to:

• Sleep disturbances: Hiccups that continue during sleep can lead to insomnia and daytime fatigue.
• Eating difficulties: Frequent hiccups can make it challenging to eat and drink normally, potentially leading to nutritional deficiencies.
• Social embarrassment: Chronic hiccups can be socially disruptive and may cause individuals to avoid social situations.
• Psychological distress: The persistent nature of chronic hiccups can lead to anxiety, depression, and decreased overall well-being.
• Physical discomfort: Prolonged hiccupping can cause chest pain, abdominal discomfort, and fatigue.

Given these potential impacts, it’s crucial for individuals experiencing chronic hiccups to seek medical attention to identify and address the underlying cause.

Coping Strategies for Chronic Hiccups

For those dealing with persistent hiccups, developing coping strategies can be helpful:

• Educate others: Explaining the condition to friends, family, and colleagues can help reduce social anxiety.
• Explore relaxation techniques: Practices like meditation or deep breathing exercises may help manage stress associated with chronic hiccups.
• Seek support: Joining support groups or speaking with a therapist can provide emotional support and coping strategies.
• Maintain a hiccup diary: Keeping track of triggers and effective remedies can help manage the condition more effectively.

By implementing these strategies, individuals with chronic hiccups can better manage their condition and minimize its impact on their daily lives.

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.

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

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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 .

Hiccups – causes, diagnosis and treatment

General characteristics

A sudden bout of hiccups may be preceded by overeating, fast food with poor chewing of solid and dry foods, swallowing air, drinking highly carbonated and alcoholic beverages. In young children and sometimes in adults, hiccups are provoked by hypothermia. Some patients begin to hiccup after taking muscle relaxants, barbiturates, benzodiazepines and other drugs. Often the symptom appears for no reason and goes away on its own within a few minutes.

At the time of an attack, a person experiences jerky muscle contractions in the epigastric region, accompanied by a protrusion of the anterior abdominal wall and a compressed sound. Due to the overlap of the glottis for a short period of time, there is a delay in breathing. A feature of hiccups is the impossibility of its conscious control. With intense hiccups, moderate pain behind the sternum, in the lower parts of the chest, is sometimes noted. Hiccups are characterized by rhythmic muscle contractions at approximately regular intervals.

Prolonged, especially pathological, hiccuping often has a debilitating effect, may be accompanied by irritability, emotional instability, increasing asthenia, vegetative manifestations – sweating of the palms, blanching or redness of the skin, a decrease in the temperature of the skin of the distal extremities. For episodes that recur several times a day or several days a week, lasting more than an hour and combined with other disorders (heartburn, pain, shortness of breath, etc.), you should seek medical help.

Classification

The main criteria used in the systematization of hiccup variants are its relationship with pathological conditions, mechanisms of development, duration. In most cases, hiccups are physiological in nature and are not associated with any disease. Pathological are called diaphragmatic myoclonus that occurs against the background of various diseases and is represented by such forms as:

• Central hiccups . It is caused mainly by disturbances in the cerebral regulation of diaphragmatic contractions. It is observed in inflammation, tumors and injuries of the brain, spinal cord. Perhaps the development of hiccups in functional disorders of the central nervous system.
• Peripheral hiccups . Associated with damage to various parts of the phrenic and vagus nerves. It is typical for volumetric processes of the mediastinum, diseases of the chest and abdominal cavity adjacent to the diaphragm.
• Reflected hiccups . It is provoked by pathological conditions in organs located outside the zone of innervation of the vagus and phrenic nerve. It can be observed against the background of enteritis, colitis, helminthic invasions and diseases of the female reproductive system.
• Toxic hiccups . It becomes a consequence of poisoning of the nervous system with endo- and exotoxins. It is detected in case of poisoning with mushroom poisons, alcohol and medicines (anesthetics, drugs), uremia, diabetic coma, terminal states.

Physiological hiccups are usually of short duration. With pathological contractions of the diaphragm, episodes of transient hiccups (from several minutes to several hours), persistent hiccups lasting more than 2 days, and long-term (from a month or more) are distinguished. Although usually prolonged hiccups indicate the presence of pathological conditions, in rare cases it can be observed in a healthy person.

Causes of hiccups

Hiccups in physiological conditions

Most often, hiccups are associated with improper eating habits: fast food, insufficient chewing of food, eating dry food, smoking on an empty stomach. Hiccups are also provoked by overeating and drinking highly carbonated drinks, which leads to distension of the stomach, irritation of the vagal receptors. With a forced position of the body, fear, the passage of large pieces of solid food in the esophageal opening of the diaphragm, the vagus nerve can be infringed. In such cases, hiccuping is protective in nature and is aimed at restoring normal innervation.

In childhood, less often in adulthood, hiccups are the result of autonomic dysfunction caused by general hypothermia. During pregnancy, the increase in episodes of hiccups is potentiated by a complex of changes occurring in a woman’s body. The leading cause is an increase in the uterus, which is accompanied by an increase in intra-abdominal pressure and a displacement of the internal organs towards the diaphragm. An additional factor is the increased emotionality of the pregnant woman.

Hiccups due to brain damage

The causes of hiccups in patients with cerebral pathology are usually irritation of structures that directly or indirectly stimulate diaphragmatic contractions. Most often, hiccups are observed in pathological formations and processes in the posterior cranial fossa. However, the occurrence of a symptom is possible with other localization of damage. Identification of frequently recurring and persistent hiccups may indicate the development of such diseases as:

• Cerebral circulation disorders . Hiccup attacks are characteristic of various types of stroke, especially hemorrhages in the ventricles of the brain. The addition of incessant hiccups serves as a prognostically unfavorable sign and is often a sign of deep destruction of the brain tissue with damage to subcortical structures.
• Inflammatory processes . Hiccups develop as part of viral encephalitis with rubella, herpes simplex, poliomyelitis, and other inflammations caused by neutrotropic viruses (tick-borne, Japanese mosquito, lethargic encephalitis, etc.). Irritation of the areas of the brain that provoke hiccups is observed in meningococcal, tuberculous, fungal and other meningitis.
• Cerebral mass neoplasms . Pathological efferent, which potentiates hiccups, occurs with cysts and other volumetric processes that compress the brain tissue. The symptom is more typical for tumors of the brain stem. In primary and metastatic malignant neoplasia, the situation is aggravated by the irritation of neurons during the germination of the neoplasm.
• Brain injuries . Causes of hiccups in patients with traumatic brain injury are swelling of the brain tissue and irritation of brainstem neurostructures due to intracranial hypertension. An additional factor is the functional disorders of neuronal metabolism, provoked by traumatic injuries and causing pathological impulses.
• Epileptic disease . Extremely rarely, hiccups become a manifestation of a simple motor paroxysm in focal epilepsy. Diaphragmatic myoclonus in such patients is the result of pathological activity of the epileptogenic focus. Often, such hiccups are combined with other types of paroxysms, precede an extended seizure in the form of an aura, and serve as a manifestation of hyperkinesis.
• Functional disorders . Hiccups can be caused by dysfunction of the reticular formation, a violation of the secretion of individual mediators or their interaction with neuronal receptors. Such conditions are typical for patients with neurosis, somatoform dysfunction of the autonomic nervous system, Birke’s syndrome. Hiccups sometimes develop during a panic attack in children.

Hiccups in spinal pathology

Since the reflex arc that causes myoclonic contractions of the diaphragm closes in the cervical segments of the spinal cord, hiccups are associated with damage to the spinal tissue. Inflammation, trauma and volume processes are sometimes accompanied by increased activity of motor neurons, from the processes of which the phrenic nerve is formed. In the presence of persistent hiccups excluded:

• Injuries of the spinal column . Damage to the gray and white matter of the spinal cord, which provokes an uncontrolled contraction of the muscle fibers of the diaphragm, is observed with bruises of the spine and compression fractures in the cervical region. With spinal cord injuries, the appearance of continuous hiccups is considered as an unfavorable sign.
• Spinal neoplasms . Pathological hiccups occur with ependymomas and other intramedullary tumors, in which segmental symptoms develop with irritation of the spinal motor neurons in the area of ​​the volumetric process. The situation is aggravated by metabolic and destructive disorders in the damaged area.
• Myelitis . Hiccups, combined with shortness of breath, impaired urination and pain sensitivity, spastic paralysis of the limbs, is detected in infectious myelopathy and spinal epidural abscess with lesions of the upper cervical region. The causative agents of inflammation that cause spinal injury are often HIV, syphilis, and coccal flora.

Hiccups in peripheral neuritis and neuropathy

Reflex development of pathological hiccups is noted in lesions of the spinal nerve roots, nerve plexuses and nerves connecting the diaphragm with the upper segments of the cervical brain. As an independent symptom, hiccups are rarely observed in patients. Often, this manifestation is combined with other focal neurological symptoms within the framework of such pathological conditions as:

• Radicular syndrome . With osteochondrosis, spondylosis, intervertebral hernias, forced contractions of the diaphragm occur due to compression of the spinal roots at the level of II-VII cervical segments, from which the phrenic nerve is formed. In addition to hiccups, patients complain of a decrease in sensitivity, pain in the back of the head, neck and above the collarbone, impaired tilt and turn of the head, and shoulder elevation. With tumors that compress the root, hypotrophy of the muscles of the neck, scapula, and shoulder girdle is often detected.
• Inflammation of the cervical plexus . The combination of hiccups with severe pain, impaired sensitivity in the ears, neck, neck and upper chest, difficulty speaking, turning and tilting the head is characteristic of cervical plexitis. Such a pathological condition can be observed with tonsillitis, influenza, tuberculosis and other infectious diseases. A provoking factor is also the compression of the plexus by enlarged lymph nodes with lymphadenitis, lymphogranulomatosis and the development of tumors in the cervical region.

Hiccups in pathology of the diaphragm

The immediate cause of hiccups is the contraction of the diaphragmatic fibers, respectively, this symptom can be detected in inflammatory, traumatic and other injuries of the muscular septum separating the chest and abdominal cavities. The prerequisites for triggering an attack of reflex hiccups depend on the characteristics of the pathological process:

• Paralysis of the diaphragm . Leading in the development of the symptom is vagal afferentation, caused by irritation of the receptors against the background of displacement of the stomach and other abdominal organs, and kink of the esophagus. In addition to intermittent episodes of hiccups, patients with diaphragmatic relaxation complain of respiratory distress, retrosternal pain and weakness after eating, and sometimes dyspepsia.
• Traumatic injuries . Often, intractable hiccups further aggravate the symptoms of closed and open diaphragm injuries, exacerbating already existing respiratory disorders. Hiccuping usually develops as a result of intense irritation of the receptors of the sensitive fibers of the phrenic nerve in violation of the integrity of the muscular septum.
• Diaphragmatic hernia . Most often, hiccups are caused by compression of the vaginal nerve at the site of its transition from the chest to the abdominal cavity. In the presence of a hernia of the esophageal opening of the diaphragm, the vagus can be compressed by the cardia and the fundus of the stomach, protruding into the mediastinum. Hiccups are often combined with retrosternal or girdle pain after eating, dysphagia, heartburn.

Hiccups in diseases of the esophagus

The symptom of frequent or prolonged hiccups is observed in esophageal pathology, in which the vagus nerve is compressed. The direct cause of hiccups is pathological afferentation aimed at implementing a protective reflex and restoring normal nerve conduction. Hiccups in combination with pathognomonic symptoms may manifest:

• Enlarged organ . The development of prolonged attacks of intractable hiccups in patients suffering from esophageal dilatation with achalasia of the cardia, its benign tumors or cancer, is due to the anatomical proximity of the organ to the vagus nerve. In addition to pathological hiccups, dysphagia and retrosternal pain are usually observed.
• Gastroesophageal reflux disease . Constant reflux of gastric contents to the esophageal mucosa leads to the appearance of erosions of the esophagus, aggravated by inflammatory processes. Increased afferentation along the sensitive fibers of the vagus against the background of irritation of the nerve endings in the membranes of the esophagus stimulates the hiccup reflex.
• Tears in the mucosa of the esophagus . A sudden intractable attack of hiccups is sometimes provoked by injuries of the mucous membrane in the cardioesophageal zone in Mallory-Weiss syndrome, which trigger the corresponding reflex arc through the fibers of the vagus nerve. In this case, hiccups are combined with bloody vomiting, sharp retrosternal pain.

Hiccups in diseases of the abdominal organs

In some patients, hiccuping is one of the manifestations of the pathology of the digestive tract, which is associated with the peculiarities of the passage of the phrenic-abdominal branches of the phrenic nerves and their anastomosis with the sympathetic plexus of the diaphragm. An additional role is played by the possible irritation of the vagus during abdominal pathological processes. An attack of hiccups can be complicated by both chronic diseases of the gastrointestinal tract (atrophic gastritis, pancreatitis) and acute pathology (intestinal obstruction due to infringement of inguinal, umbilical and femoral hernias).

Episodes of hiccups are possible with pathological processes in the right hypochondrium: subphrenic abscesses, attacks of cholecystitis, biliary colic. A feature of such conditions, in addition to signs of organ damage, is the identification of a phrenicus symptom, indicating irritation (irritation) of the phrenic nerve. Sometimes hiccups occur with abdominal trauma and during abdominal operations, which is associated mainly with vagal effects. For enteritis, colitis, giardiasis and helminthiases, the so-called reflected hiccup is characteristic.

Hiccups in thoracic pathology

The symptom in people suffering from cardiological, bronchopulmonary and mediastinal diseases is usually caused by irritation of the vagus nerve, which passes in the mediastinum near the esophagus. With the localization of the pathological focus in the region of the diaphragm, stimulation of diaphragmatic receptors that trigger hiccups is possible. The combination of hiccups with pain radiating to the shoulder girdle and neck is typical for mediastinal teratomas that compress the vagus.

Hiccups that occur with dry diaphragmatic pleurisy often make diagnostic search difficult. Its combination with flatulence, abdominal tension, pain in the hypochondrium and abdominal cavity is often mistakenly interpreted as an additional sign of an acute abdomen. A similar situation is noted in the leading abdominal syndrome in patients with pulmonary embolism and severe dyspeptic symptoms in pulmonary infarction. In sporadic cases, hiccups against the background of dull pain in the chest and signs of heart failure are manifested in postcardiotomy syndrome.

Hiccups in gynecological diseases

Reflected hiccups are sometimes observed in the pathology of the uterus and appendages (endometritis, adnexitis, benign and malignant tumors). The mechanism of its occurrence is still unclear, although the role of complex regulatory interactions involving sympathetic and parasympathetic fibers of the visceral nervous system is not ruled out. In addition, autonomic dysfunction causes the development of hiccups in algomenorrhea. Patients also experience functional disorders of many systems: dyspepsia, fainting, palpitations, etc.

Hiccups in case of intoxication

The appearance of agonal hiccups is a formidable sign of an unfavorable course of severe diseases and terminal conditions. Usually, the development of a symptom indicates gross metabolic disorders in the brain tissue, dysfunction of the nuclei of the medulla oblongata and subcortical structures. Hiccups of central origin are observed in severe metabolic disorders caused by functional insufficiency of various organs and systems – hepatic, uremic and diabetic coma. Intoxication hiccups are possible with burn disease, cancer cachexia.

The most common causes of exogenous intoxication occurring with hiccups are poisoning by various substances: alcohol, muscle relaxant, sedative and anesthetic drugs, and some hormonal agents. The probable cause of the symptom is considered to be brain dysfunction with an imbalance of excitatory and inhibitory influences, a change in the metabolism of neurons, and the formation of foci of pathological activity.

Examination

Diagnostic search aimed at clarifying the causes of hiccups is carried out in case of its combination with other symptoms, frequent occurrence, duration of attacks more than 60 minutes. The examination plan is drawn up taking into account the anamnesis and concomitant symptoms. Most often, the primary diagnosis is carried out by a gastroenterologist, who, according to indications, involves other specialists in examining the patient. Depending on the alleged cause of the symptom, for the purpose of express diagnostics, the following are used:

• Endoscopy . Gastroscopy is the most informative method that allows you to quickly objectify pathological changes in the esophagus and stomach. When volumetric formations, erosions and ulcers are detected during endoscopy, a biopsy is performed for histological analysis of the material.
• X-ray methods . Abdominal x-rays, chest x-rays are performed to detect gastrointestinal pathology, diaphragm relaxation, pleurisy, mediastinal tumors, and other possible causes of hiccups. Further, ERCP and other X-ray contrast techniques are used.
• Ultrasound . Abdominal sonography is performed to assess the echostructure of the main parenchymal organs and identify free fluid, if indicated, it is supplemented by ultrasound of the gallbladder and liver. If pleurisy is suspected, mediastinal tumors are indicated by ultrasound of the pleural cavity and mediastinum.
• Tomography . With insufficient information content of radiography and sonography, CT, MSCT and MRI of the abdominal or thoracic cavities, individual organs are performed. MRI of the head and spine are highly accurate in the diagnosis of cerebral and spinal pathology. In difficult cases, an MRI of the whole body is performed.
• Electrofunctional tests . After exclusion of abdominal and thoracic causes of hiccups, electroencephalography is recommended. The method reveals foci of pathological activity in the brain. To clarify the level of lesions of the nervous system, electroneurography and electromyography are also performed.
• Complete blood count . With high leukocytosis, a shift of the leukocyte formula to the left, increased ESR, further diagnostic search is aimed at identifying inflammatory and neoplastic processes. The analysis is often supplemented with the study of enzymes (ALT, AST), determination of the level of C-reactive protein.

Upon receipt of preliminary information about a possible disease that provoked hiccups, further examination is performed according to the appropriate protocol and may include a wide range of laboratory and instrumental methods. Differential diagnosis is carried out between various pathological processes in which the development of hiccups is possible.

When hiccups, it is recommended to drink water in small sips.

Symptomatic therapy. Sometimes for their faster relief it is enough to be distracted, take a deep breath 2-3 times, hold your breath for a while or drink a couple of sips of water. If the attack continues, despite the distraction and reflex methods being taken, taking into account the patient’s condition, it is recommended to contact the local or family doctor, who will prescribe a further examination, or call an ambulance if the patient’s condition quickly worsens.

Before hospitalization and examination to stop hiccups, a healthcare professional can stimulate some reflexogenic zones in the face and exit points of the phrenic nerve, insert a catheter intranasally to a depth of 12 cm. Sometimes an intravenous infusion of calcium preparations has a stopping effect. With a probable central and especially psychogenic genesis of hiccups, sedative herbal preparations, tranquilizers and neuroleptics are used.