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Why hiccups are caused: Hiccups – Symptoms and causes

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What Causes the Hiccups?

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Here are some of the causes of hiccups and tips on getting rid of them. Nov. 24, 2015

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What Causes Hiccups? | Mental Floss

The cause of hiccups depends on whom you ask. The ancient Greek physician Galen thought hiccups were violent emotions erupting from the body, while others thought they were a sign of liver inflammation. Today, evidence points to spasms in the diaphragm, the large muscle between the chest and abdomen that aids airflow during breathing. This involuntary contraction can be brought on by a number of things that might irritate the nerves that control the movement of the muscle. A full stomach, heavy boozing, rapid shifts in temperature either inside or outside of the stomach, and certain emotions like shock or excitement are all common culprits.

No matter the cause, the result is the same: The diaphragm spasms and causes us to take a quick breath. The sudden rush of air causes the epiglottis (the flap that protects the space between the vocal cords) to shut and interrupt the breath, which makes the familiar “hic” sound.

WHAT CURES THEM?

The best cure for hiccups also depends on the person you ask. Almost all cures are based on one of two principles: One type works its magic by overwhelming the vagus nerve with another sensation. The vagus nerve is a cranial nerve that innervates the stomach and conveys sensory information about the body’s organs to the brain. When distracted by overwhelming information of another sort, it basically tells the brain that something more important has come up and the hiccuping should probably be stopped (vagus nerve stimulation is also used to control seizures in epileptics and treat drug-resistant cases of clinical depression). The other method for curing hiccups is to interfere with the breathing, increasing the amount of carbon dioxide in the blood, and causing the body to focus on getting rid of the of the CO2 and not making hiccups.

Swallowing a spoonful of sugar is probably the most commonly prescribed hiccup cure and falls into the first category. A teaspoon of sugar is usually enough to stimulate the vagus nerve and make the body forget all about the hiccups. Even ardent supporters of the sugar cure disagree if the sugar should be taken dry or washed down with water, though.

If this home remedy doesn’t work, and your hiccups are both severe and persistent, you may need to bring out the big guns. For chronic cases like this, doctors sometimes use a cocktail of Reglan (a gastrointestinal stimulant) and Thorazine (an anti-psychotic with sedative properties) to quiet things down. In some cases that resist these drugs, Kemstro, an anti-spasmodic, is also used. Other doctors have used vagus nerve stimulators implanted in the upper chest of patients. The pacemaker-like devices send rhythmic bursts of electricity through the vagus nerve to the brain to keep the hiccup cycle in check.

Many people prefer home remedies to battle their hiccups, which may include holding your breath, gargling ice water, or breathing into a paper bag. While the same people will swear by the treatment they’ve been using all these years, there’s no firm scientific consensus that any of them actually work. But if it helps you, isn’t that all that matters?

Have you got a Big Question you’d like us to answer? If so, let us know by emailing us at [email protected]

An earlier version of this article appeared in 2012.

Hiccups: why do we hiccup?

Most of us have experienced hiccups, an uncomfortable, sometimes embarrassing, but usually short-lived experience. But sometimes hiccups persist for a long period of time and can be a sign of serious underlying disease.

What are hiccups?

Hiccups are bursts of inspiratory (breathing in) activity. The muscles we use when we take in a breath are the intercostal muscles situated between the ribs, and the diaphragm — a sheet of muscle below the lungs. A hiccup is an involuntary contraction of the diaphragm, which is followed by the sudden closure of your vocal cords – this produces the characteristic hiccup sound.

Causes of hiccups

Hiccups are very common and most people will have hiccups at some time. Most simple cases of hiccups come after eating or drinking too much or too quickly. The stomach, which is situated right below the diaphragm, becomes distended and irritates it. This will cause the diaphragm to contract, as it does when we breathe in.

Carbonated fizzy drinks can cause hiccups, and alcohol is another common cause of hiccups. Excess smoking may also cause hiccups. Hot and spicy food, such as curry, may trigger hiccups.

Sometimes hiccups will occur because of a disturbance to the nerve pathways from the brain to the muscles involved. This explains why hiccups may occur with temperature changes or emotional situations. It is also the reason that a sudden shock can sometimes abolish an attack.

Persistent hiccups may signify problems in the brain (such as stroke, tumours, infections or multiple sclerosis), spinal cord or any of the structures around the diaphragm or chest wall. So chronic hiccups that last days, months or even years, may indicate serious underlying disease and should be investigated.

Treatment

Everyone has their own pet remedy for curing hiccups. Simply holding your breath is often effective for short-term bouts of hiccups, but usually they will go away of their own accord. Some people find that touching or gently lifting their uvula (the dangly structure at the back of the throat) with a cotton bud or similar will stop a bout of hiccups, but be aware that this will stimulate the gag reflex.

Other methods include drinking ice cold water, swallowing something sweet like a spoonful of sugar, or sitting down, while leaning forward and pulling your knees up to compress your chest.

If you have hiccups that have gone on for 2 days or longer, or are having recurrent bouts of hiccups, you should see a doctor to find out if there is an underlying cause that needs treating.

What your doctor can do for you

If you are having problems with hiccups, your doctor can:

  • rule out serious underlying diseases that provoke hiccups;
  • prescribe antispasmodics;
  • treat underlying diseases that may be causing hiccups; or
  • refer you to a surgeon who may recommend surgery on the nerves supplying the diaphragm, if you have severe or persistent hiccup attacks.

1. Patient.co.uk. Hiccups (hiccoughs). Last checked June 2011. http://www.patient.co.uk/health/hiccups-hiccoughs (accessed Aug 2013).
2. Mayo Clinic. Hiccups. Last reviewed June 2011. http://www.mayoclinic.com/health/hiccups/DS00975 (accessed Aug 2013).

Why Hiccups Happen and How to Stop Them

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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

We’ve all heard wacky advice on how to stop hiccups. Stand on your head, drink water upside down, get a friend to scare you—we’ll try just about anything to rid ourselves of the hiccups.

Hiccups are a nervous system reflex that causes the diaphragm muscle, located under your lungs, to contract involuntarily. Many can cause hiccups, and they can also happen for no reason. There are many home remedies for getting rid of hiccups—some based in science, some not so much.

Methods supported by science include drinking water, applying a cold compress to your face, and changing your breathing pattern. Let’s look at what the heck hiccups are and what techniques may help shorten how long they last.

There’s no cure for hiccups, but there are lots of treatments that may help shorten episodes. Many cases of acute hiccups resolve on their own and don’t require any intervention. 

How you handle hiccups depends on how long they last. For acute hiccups, home remedies and physical maneuvers exist that may help decrease the duration of hiccups. Most involve a sudden change that interrupts the reflex that causes hiccups.

Below are hiccup remedies proposed by physicians throughout history, and while they might work for you and likely won’t do any harm, they have yet to be proven remedies (Petroianu, 2014):

  • Stimulate the ears, nose, and throat

The first set of remedies involves stimulation of the ears, nose, and throat. One easy thing to try to help shorten a bout of hiccups is to drink cold water (Steger, 2015). Using smelling salts, plugging both ears while drinking water, and swallowing crushed ice are other ways to stimulate these areas (Brañuelas Quiroga, 2016). 

  • Activate the vagus nerve 

Your vagus nerve is a super long nerve that starts in the brain and runs down to your digestive system. Some people believe that stimulating  this nerve can help alleviate hiccups. Scaring someone or applying a cold compress to your face are both ways to activate the vagus nerve (Brañuelas Quiroga, 2016).

  • Altering respiratory patterns 

Changing the way you breathe or doing something to shake up your respiratory patterns may shorten a hiccuping spell. Holding your breath, coughing, and breathing into a paper bag are some examples of how to do this (Steger, 2015).

The Valsalva maneuver is a technique whereby you breathe out against a closed nose and mouth, engaging your abdominal muscles. It happens naturally when you go to the bathroom or when you lift something heavy. There’s some evidence that it can help with hiccups by increasing pressure in the chest. Here’s how to do it (Petroianu, 2014):

  1. Take a deep breath and hold it.
  2. Hold your nose closed.
  3. Tighten the muscles in your chest and stomach.
  4. Hold for 10-15 seconds.
  5. Rapidly release your breath.

Hiccups are medically known as singultus, a latin word that translates to “sobbing” or “gasping” (Steger, 2015). 

Hiccups are caused by involuntary contractions of the diaphragm and often the muscles between the ribs. The diaphragm normally contracts rhythmically, pulling our lungs down and pulling air into them to control our breathing. But when the muscle begins to spasm, it causes us to breathe in involuntarily, resulting in hiccups.

After the diaphragm spasms, the opening between your vocal cords closes rapidly. This cuts off air intake and causes that characteristic “hic” sound. Hiccups can happen anywhere from four to 60 times per minute (Steger, 2015).

There are four types of hiccups: acute, persistent, intractable, and recurrent. Types of hiccups are characterized by how long they last (Brañuelas Quiroga, 2016). Any hiccupping episode that lasts longer than two days is considered chronic.

  • Acute hiccups: These are the most common and last for less than 48 hours. Although acute hiccups can persist for up to 48 hours, these episodes often last for a few minutes or less. Acute hiccups rarely require medical attention and generally stop on their own.
  • Persistent hiccups: This type lasts more than 48 hours but less than one month.
  • Intractable hiccups: These hiccuping spells last more than one month (Steger, 2015). These hiccups are often caused by an underlying condition and should be evaluated by a healthcare provider.
  • Recurrent hiccups: These are frequent bouts of hiccups that last longer than acute hiccups.

Often the cause of hiccups is unknown, especially in acute cases (Brañuelas Quiroga, 2016). 

Common causes of hiccups include overeating or consuming carbonated drinks. Other things that can trigger the reaction include spicy foods, alcohol, smoking, and anything that irritates your stomach or respiratory system. Research has also found that anxiety and over-excitement can bring on a bout of hiccups (Steger, 2015).

Most of the time hiccups are annoying, sometimes even funny, but there are occasions where the phenomenon might be a sign of something more serious. If hiccups are persistent, recurrent, or challenging to treat, it may indicate an underlying medical problem. 

Unfortunately, the mysteries around hiccups continue. Hiccups are a symptom of more than 100 health conditions, doctors have discovered, so it can be difficult to attribute them to one issue or another. Some of the more well documented medical conditions associated with hiccups include (Steger, 2015):

  • Central nervous system and brain disease or injury
  • Gastrointestinal disease or gastrointestinal reflux (aka GERD)
  • Heart disease
  • Ear, nose, or throat conditions

Exposure to toxins and using recreational drugs can also be a cause. Hiccupping may be a side effect of certain medications, including benzodiazepines, opiates, and steroids (Steger, 2015).

For persistent or intractable hiccups, the first thing to do is seek medical advice. If there is another health problem at play, it’s best to treat what’s causing hiccups in the first place (Brañuelas Quiroga, 2016). 

If you live with chronic hiccups, there are medications that can help. Here are some common drugs to treat persistent or intractable hiccups (Steger, 2015): 

  • Haloperidol 
  • Metoclopramide 
  • Baclofen 
  • Phenytoin 
  • Valproic acid 
  • Carbamazepine 
  • Gabapentin 
  • Amitriptyline 
  • Chlorpromazine 
  • Amantadine

Hiccups are annoying but usually stop on their own without medical treatment. 

As you can see, there are many things you can try at home to shorten the duration of a hiccupping spell. If your hiccups don’t stop within 48 hours, speak with a healthcare professional to see if there’s something health-related causing your hiccups.

  1. Brañuelas Quiroga, J., Urbano García, J., & Bolaños Guedes, J. (2016). Hiccups: A Common Problem with Some Unusual Causes and Cures. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 66(652), 584–586. DOI: 10.3399/bjgp16X687913. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072913/
  2. Petroianu, G. A. (2014). Treatment of Hiccup by Vagal Maneuvers. Journal of the History of the Neurosciences, 24(2), 123–136. DOI:10.1080/0964704x.2014.897133. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25055206/
  3. Steger, M., Schneemann, M., & Fox, M. (2015). Systemic Review: The Pathogenesis and Pharmacological Treatment of Hiccups. Alimentary Pharmacology & Therapeutics, 42(9), 1037–1050. DOI: 10.1111/apt.13374. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26307025/

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Lesional location of lateral medullary infarction presenting hiccups (singultus)

Lateral medullary infarction (LMI) or Wallenberg’s syndrome is one of the best known vascular syndromes of the posterior circulation, along with events such as occlusion of the posterior inferior cerebellar artery or the vertebral artery. The usual symptoms of LMI include vertigo, dizziness, nystagmus, ataxia, nausea and vomiting, dysphagia, hoarseness, hiccups, impaired sensation over half the face, impairment of pain and thermal sensation over the contralateral hemibody and limbs and the ipsilateral face, and Horner’s syndrome.1–3

Among the symptoms, hiccups (medical term, singultus) can easily be overlooked, though among other effects they may cause aspiration pneumonia, respiratory depression, and oesophagitis.4 The aetiology of hiccups includes failure of the digestive organs, irritation of the diaphragm, ingestion of alcohol, excessive smoking, and any disease of the central nervous system that involves the brain stem.5–7 LMI in particular can be accompanied by hiccups. Unlike other symptoms and signs of LMI, however, the anatomical lesion of hiccups is not well known.3

In this study we investigated anatomical lesions in patients with LMI suffering from hiccups, using brain magnetic resonance imaging (MRI).

METHODS

Subjects

We investigated 51 patients with LMI admitted to our department of neurology between 1997 and 2002. All patients underwent MRI, which identified a medullary lesion compatible with the clinical symptoms and signs of LMI. They also had plain x rays of the chest and abdomen and general blood testing. Neurological evaluation sought symptoms and signs of LMI such as vertigo, dizziness, nystagmus, ataxia, nausea and vomiting, dysphagia, hoarseness, hiccups, Horner’s syndrome, impaired sensation over half the face, and impaired sensation over the hemibody and limbs.

For the evaluation of neuroanatomical lesions, we excluded any patients who might have had other causes of hiccup, such as gastrointestinal disease, irritation of the diaphragm, mediastinal or cervical disease, other CNS disease, metabolic disorders, drug treatment, and psychogenic causes.5–7 Among LMI patients with hiccups, eight who had other possible causes were excluded: two who had chronic gastritis with gastric distension, one who smoked excessively, and five who had been intubated (intubation may stimulate the glottis).

Where a nasogastric tube had been inserted, we only included patients who had hiccups before the tube was inserted and continued to have hiccups for more than 12 hours after it was removed.

After these exclusions, only seven patients were chosen for the study (five male, two female), age range 40 to 80 years, mean (SD) age, 58.14 (16.17) years.

Neurological lesion

All patients had an MRI scan, which was done on a 1.5-Tesla scanner (Vision Plus, Siemens Magnetom, Erlangen, Germany), within three days from the time of admission to hospital. Images were obtained using the fast-spin-echo method. The imaging protocol involved T1 weighted (time of repetition (TR) 570 ms, time of echo (TE) 20 ms) and T2 weighted (TR 4200 ms, TE 96 ms) transverse scan images in the horizontal plane at 5 or 6 mm intervals. Three axial sections of the medulla were identified as the lower, middle, and upper levels based on a study by Bradley. 8 Axial cuts were further classified into intralevel lesion loci on the basis of a study by Kim et al.9 The lower level was set at the termination of the fourth ventricle, and was divided into paramedian (PM), inferior-dorsal (ID), and inferior-dorsolateral (IDL) regions. The middle level was set at the centre of the inferior olivary nucleus, and was classified into PM, midlateral (ML), and dorsolateral (DL) regions. The upper level was set at the pontobulbar junction and was split into PM and ML.

RESULTS

As shown in fig 1, among LMI patients with hiccup, two cases had lesion loci at the middle and lower levels, and four cases at the middle and upper levels. Although one case (patient 6) had lesions over all levels of the medulla, we included this case in the analysis because the lesions were mainly located in the middle level. The lesions in the three cases involving the lower level of the medulla were all in the IDL region. Among the middle level lesions, six were in the DL region, one in the PM region, and one in the ML region. The lesions in the upper level all occurred in the ML region.

Figure 1

 Characteristics of lateral medullary infarction patients with hiccups. *L, lower; M, middle; and U, upper. †L, left; R, right. ‡ID, inferior-dorsal; IDL, inferior-dorsolateral; DL, dorsolateral; PM, paramedian; ML, midlateral. ¶DP, dysphagia; GA, gait ataxia; HN, Horner’s sign; HS, hoarseness; IB, impaired sensation over the body; IF, impaired sensation over half the face; NS, nystagmus; N/V, nausea/vomiting; VD, vertigo/dizziness.

All seven subjects showed accompanying symptoms such as vertigo, dizziness, nausea/vomiting, and dysphagia. Ataxia was observed in six subjects; five experienced hoarseness, impaired sensation over half the face, and impaired sensation over the body, while three had Horner’s syndrome. One subject had nystagmus. Based on the structural involvement in LMI,1,3 five of the seven cases had involvement the fifth nerve, with, for example, impaired sensation over half the face; six of the seven had involvement of the restiform body and cerebellar connections, with ataxia; variable numbers had involvement of the vestibular nuclei and connections, manifesting as vertigo, nausea and vomiting, and nystagmus; three of the seven cases had involvement of the descending sympathetic tract, with Horner’s syndrome; and all cases had involvement of either the ninth or the tenth cranial nerves or both, with dysphagia and hoarseness.

DISCUSSION

Hiccups are repeated involuntary, spasmodic, and temporary contractions of the diaphragm accompanied by sudden closure of the glottis, producing a distinguishing “hic” sound.5 It is suggested that hiccups are caused by the failure of the reciprocal inhibition of the valve control of the pharynx and larynx.10 This dynamic valve function is achieved by alternating excitation-inhibition of two structures: the glottis closure complex (GCC) and the inspiratory complex (IC). Activation of the GCC consists of the backward swing of the epiglottis of the vocal cords, contraction of the hyoid muscles and the superior constrictor of the pharynx, relaxation of the upper oesophageal sphincter, and activation of the IC, made up of diaphragmatic, exterior intercostal, sternocleidomastoid, anterior serratal, and scalene contraction. The IC is activated within 30–40 ms. Paradoxical activation of the GCC causes tonic phasic inspiratory obstruction. The hiccup, with its unique sound, then occurs.

The physiological purpose of hiccups is uncertain. Because fetuses and premature infants hiccup often, it is suggested that hiccups are a programmed isometric inspiratory muscle exercise, which is useless after the neonatal period but may be restimulated by irritation along the reflex arc.11

The neuroanatomical centre for hiccups is not well known, although the central connection is presumed to be a part of the brain stem which probably interacts with its respiratory centres, phrenic nerve nuclei, medullary reticular formation, and hypothalamus. 3,7,12 The afferent pathway is made up of the sensory branches of the phrenic and vagus nerves and the dorsal sympathetic fibres, while the efferent pathway is formed by the motor fibres of the phrenic nerve.13

Hiccups have central and peripheral causes.5,14 Central hiccups occur with lesions between the pathway from the central nervous system to the phrenic nerve, mainly in diseases of the brain stem such as ischaemic stroke, dolichoectatic basilar artery, tumours, encephalitis, and multiple sclerosis.12,13,15,16 The role of the central nervous system is suggested by the complex physiological mechanism of hiccup, which requires an interaction in the supraspinal polysynapsis.13 Peripheral hiccups can be caused by diseases at phrenic nerve level such as gastric distension.5,6

We cannot identify the mechanism of hiccup in patients with LMI, but we can make a few assumptions. First, it is likely that there is denervation supersensitivity because palatal myoclonus is common in such patients.14,15,17 Loss of supranuclear control occurs in the brain stem, especially at ponto-medullary level—the so called myoclonic triangle of Guillan-Mollaret consisting of the dentate nucleus, the inferior olivary nucleus, and the red nucleus. Denervation supersensitivity leads to hiccup. Nonetheless, the region of the myoclonic triangle of Guillan-Mollaret usually involves the peduncle rather than the medulla. Hiccups occur several weeks after the onset of denervation, when enlargement of the inferior olivary nucleus is observed. The patients in our study, however, developed hiccups on the day of the brain infarction or on the next day, and brain MRI did not show any particular lesion in the Guillan-Mollaret triangle. This mechanism was therefore not able to explain hiccups in lateral medullary infarction.

Hiccups occur because LMI causes an imbalance between expiration and inspiration. 1,18 The expiratory centre and the inspiratory centre are in the central medulla (fig 2). The areas involved are known to overlap, the expiratory area being larger than the inspiratory area and extending more laterally and dorsally in the reticular formation of the medulla. The expiratory centre is also larger, and lies in the outer side of the medulla. Thus, if the lesion is around the nucleus ambiguus of the medulla, the expiratory centre is destroyed, causing an imbalance between expiration and inspiration and consequently leading to hiccups.

Figure 2

 Major lesions of lateral medullary infarction in patients with hiccups on T2WI magnetic resonance imaging.

In addition, hiccups may stem from ischaemia of the dorsal motor nucleus of the vagus or the nucleus of the solitary tract located beneath the lateral part of the floor of the fourth ventricle in the dorsal medulla, medial to the vestibular nuclei. 2 As well as being caused by LMI, hiccups reportedly occur because of angiomas in the medulla,5 primary medullary haemorrhage,19 and tumours or tuberculomata in the brain stem.15 These are all located in the dorsolateral medulla. Five cases in our study occurred in the dorsolateral medulla. In animal experiments,20 hiccup-like responses can be generated by electrical stimulation of the medullary reticular formation lateral to the nucleus ambiguus at the rostrocaudal level, between 1 mm and 2.5 mm rostral to the obex of the fourth ventricle of a cat. This is mainly the region of the dorsolateral medulla, where the nucleus ambiguus is located—including the vagal motor neurones projecting to the larynx and the premotor neurones that control the diaphragm.21,22 Thus lesions in this region induce hiccups, as they affect the laryngeal motor neurones which control the glottis and the premotor neurones which control the inspiratory muscles. 23 If the nucleus raphé magnus—with GABAergic inhibitory cells in the medullary reticular formation of the outer region of the nucleus ambiguus—is destroyed hiccups are induced.23

The clinical features of hiccups in LMI have been described.1,2,24–26 The frequency of hiccup is around 12–36% in this condition. Nonetheless, the frequency of LMI itself is relatively low, and most studies involved only 20 to 40 patients, with differing frequencies of LMI. Data from a previous study on LMI2 showed that 44 of 172 patients (around 26%) developed hiccup.2 In our study, seven of 51 patients (14%) developed hiccup.

Hiccups in LMI are often accompanied by symptoms involving the fifth, ninth, and tenth cranial nerves, with nausea and vomiting.1 In the present study, all the affected patients had symptoms involving either the ninth or the tenth cranial nerve or both, six involved the cerebellar connections, five had symptoms of fifth cranial nerve involvement, and all cases had symptoms caused by involvement of the vestibular nuclei and their connections (figs 2 and 3). From our analyses of symptoms and lesion locations, we thought that the hiccup centre—the possible area of involvement necessary to produce hiccups—was placed in the region of the cerebellar, vestibular, and ninth, tenth, and fifth cranial nerve nuclei, and their connections with the middle part of the medulla. The lesion appears to be mainly in the dorsolateral region of the middle medulla. One might expect that such a lesion could also induce hiccups through an imbalance between expiration and inspiration, because it is situated around the respiratory area. This has been suggested in previous studies.1,18

Figure 3

 Schematic transverse section of the medulla. Cell columns related to functional components of important structures are indicated on the left. On the right, the hypothesised critical region involved in the development of hiccups is indicated by the dark oval.

Unfortunately, our study has some limitations. Only 1.9% of all cerebral infarcts are in the lateral medulla,24 and our yield of only seven patients reflects this. It is therefore difficult to obtain enough patients for an adequate sample. In addition, few of the patients with LMI developed hiccup. Patients with dysphagia and secondary hiccup caused by oral secretions or irritation of the airway from dysphagia cannot easily be distinguished from those with a central cause. From previous studies, however, LMI patients experience hiccups during sleep before developing dysphagic symptoms, and the hiccups do not cease in parallel with recovery from the dysphagia.1 While MRI is the preferred imaging technique for vertebrobasilar territory infarcts, and we used an anatomical approach at three different levels and two or three intralevel areas in the medulla in order to minimise errors in locating the infarcts, there may nevertheless be sources of investigational bias; these could arise from variations in the thickness of the MRI slices and the gaps between them, and uncertainties in forming the reference line used to section the brain stem.

Conclusions

Around 14% of patients with lateral medullary infarcts had hiccups in our study, mainly when the lesions occurred in the dorsolateral region of the middle medulla. There was a close correlation between hiccups and symptoms of cerebellar, vestibular, and fifth, ninth, and tenth cranial nerve involvement. Although there may be arguments against assigning a simple lesional location to such a complicated process as hiccup, the development of hiccup does appear to be related to lesions in the dorsolateral region of the middle medulla. A larger study is necessary to define the anatomical correlates of hiccup with more certainty.

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  13. Fodstad H, Nilsson S. Intractable singultus: a diagnostic and therapeutic challenge. Br J Neurosurg1993;7:255–60.

  14. Musumeci A, Cristofori L, Bricolo A. Persistent hiccup as presenting symptom in medulla oblongata cavernoma: a case report and review of the literature. Clin Neurol Neurosurg2000;102:13–17.

  15. al Deeb SM, Sharif H, al Moutaery K, et al. Intractable hiccup induced by brainstem lesion. J Neurol Sci 1991;103:144–50.

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  17. de la Fuente-Fernandez R. [Hiccup and dysfunction of the inferior olivary complex]. Med Clin (Barc)1998;110:22–4.

  18. Hoff HE, Breckenridge CG. The neurogenesis of respiration. In: Fulton JF, ed. A textbook of physiology. Philadelphia: WB Saunders Co, 1955:843–9.

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  20. Arita H, Oshima T, Kita I, et al. Generation of hiccup by electrical stimulation in medulla of cats. Neurosci Lett 1994;175:67–70.

  21. Arita H, Sakamoto M, Hirokawa Y, et al. Serotonin innervation patterns differ among the various medullary motoneuronal groups involved in upper airway control. Exp Brain Res 1993;95:100–10.

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  23. Oshima T, Sakamoto M, Tatsuta H, et al. GABAergic inhibition of hiccup-like reflex induced by electrical stimulation in medulla of cats. Neurosci Res 1998;30:287–93.

  24. Norrving B, Cronqvist S. Lateral medullary infarction: prognosis in an unselected series. Neurology1991;41:244–8.

  25. Sacco RL, Freddo L, Bello JA, et al. Wallenberg’s lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol 1993;50:609–14.

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Hiccups: causes and cures – Today’s Parent

What causes this irritating phenomenon — and is there a cure?

Photo: Chuck Schmidt/Getty Images

There are few things more normal — yet peculiar — than a bout of hiccups. This is especially true for children and babies, who are more prone to this annoying occurrence than adults. No doubt you felt your little one hiccupping away in utero and wondered what caused it.

Hiccups happen when your respiratory muscles involuntarily contract. Your diaphragm flexes and draws in air, and the glottis (the muscle that protects the entrance to the lungs and surrounds the vocal chords) snaps shut, causing the telltale “hic” sound.

Read more: Health issues for little bodies>

The mystery of why

“A hiccup has no clear value,” says Mark Feldman, the director of Community Paediatrics at the University of Toronto. He compares the spasm to another involuntary respiratory reaction that does have a practical purpose: “A cough clears your air passage and can be a life-saving reflex.” Not true of the hiccup, so scientists have long attempted to search out the raison d’être.

A 2003 French study concluded that hiccups may be vestigial behaviour from when we had gills, because the physiological act of hiccupping mirrors the way some amphibious creatures gulp in water to get oxygen. It’s thought that the function was preserved as we evolved because the sharp intake of breath helps in the suckling action of nursing.

Whatever the reason, your child’s hiccups are likely nothing to worry about. “Pretty much all kids get hiccups at one time or another, and in almost all cases they’re completely benign,” says Feldman. Very rarely, a person will get hiccups for longer than 48 hours, known as persistent hiccups. Rarer still are intractable hiccups, which last for two months or longer. These types of hiccups usually occur in adults, and can be brought on by a neurological event, like a stroke. In the unlikely event that your child hiccups for more than two straight days, a doctor’s visit is recommended.

A cure for hiccups?

While they may cause discomfort, hiccups will simply go away as mysteriously as they arrived. Of course, there are dozens of home remedies, including holding your breath, having someone scare you, or eating a teaspoon of sugar or peanut butter. But there’s no scientific evidence that these acts do anything at all. “At best, they provide a distraction that takes up time, during which the hiccups go away on their own,” says Feldman.

Read more: 7 hiccup home remedies (that work!)>

 

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90,000 Hiccups turned out to be a symptom of a fatal disease

https://ria.ru/20211019/ikota-1755128016.html

Why ignoring hiccups is deadly

Hiccups turned out to be a symptom of a fatal disease – RIA Novosti, 19.10.2021

Why ignoring hiccups is deadly dangerous

Frequent hiccups may indicate cancer. Express writes about this with reference to the data of British doctors. RIA Novosti, 19.10.2021

2021-10-19T01: 35

2021-10-19T01: 35

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MOSCOW, October 19 – RIA Novosti. Frequent hiccups may indicate cancer. Express writes about this, citing data from British doctors. Hiccups, as a rule, arise from excessively fast food intake, too much food or alcohol. However, in some cases, this symptom signals the occurrence of esophageal cancer. “Signs of cancer may appear if your stomach stops working properly, and you notice that it is swollen for no apparent reason,” – quotes the publication of the words of Dr. Hussein Abdeh.Persistent hiccups, the attacks of which last more than 48 hours, require immediate medical attention, experts warn. Esophageal cancer is a malignant tumor emanating from the lining of the esophagus. The main symptoms of this disease are progressive impairment of swallowing first solid food, later – liquid food, as well as unintentional weight loss. The main risk factors that can cause esophageal cancer include the constant intake of hot, rough and poorly chewed food, drinking alcohol, smoking , as well as thermal and chemical burns of the esophagus.Previously it became known that nausea and vomiting after eating, feeling coma and the lower esophagus and disruption of the passage of food are early signs of gastric cancer.

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01:35 19.10.2021 (updated: 04:15 19.10.2021)

Hiccups turned out to be a symptom of a fatal disease

MOSCOW, October 19 – RIA Novosti. Frequent hiccups may indicate cancer. Express writes about this with reference to the data of British doctors.

Hiccups are usually caused by eating too quickly, eating too much or drinking too much alcohol. However, in some cases, this symptom signals the occurrence of esophageal cancer.

“Signs of cancer may appear if your stomach stops working properly, and you notice that it is swollen for no apparent reason,” – quotes the publication of the words of Dr. Hussein Abdeh.

Persistent hiccups, the attacks of which last more than 48 hours, require immediate medical attention, experts warn.

July 21, 11:27 pm

Doctors have named an unexpected symptom of “silent” cancer in women

Esophageal cancer is a malignant tumor originating from the lining of the esophagus. The main symptoms of this disease are progressive impairment of swallowing first solid food, later – liquid, as well as unintentional loss of body weight.

The main risk factors that can cause esophageal cancer include the constant intake of hot, rough and poorly chewed food, alcohol, smoking, as well as thermal and chemical burns of the esophagus.

It was previously known that nausea and vomiting after a meal, feeling of coma in the lower esophagus and poor passage of food are early signs of gastric cancer.

Why hiccups occur and how to get rid of it quickly.Politeka

Each person has repeatedly thought about how to get rid of hiccups. Hiccups are an involuntary, usually rhythmically repetitive short and strong breath with a sharply narrowed or closed glottis, caused by a convulsive contraction of the diaphragm. Hiccups occur for no apparent reason and usually go away on their own after a while. But what can you do to stop hiccuping as soon as possible

Causes of hiccups

Hiccups are not a disease in itself, it happens to absolutely everyone. The reasons for hiccups can be different. With it, the diaphragm begins to move in jerks and a stream of air enters the larynx. When this flow reaches the vocal cords and the sound characteristic of hiccups appears, well known to all of us.

Hiccups can occur from soda consumption, overeating, excessive alcohol consumption, temperature changes or emotional stress. Such hiccups usually go away rather quickly and last about 5-20 minutes.

These include heart problems, diabetes, diseases of the central nervous system, damage to the vagus nerve or laryngitis. In such cases, hiccups last much longer and sometimes do not go away for days. With a long duration of hiccups, you need to consult a doctor, and he will be able to find out its exact cause.

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Hiccups, that last more than 48 hours, can be caused by many factors, which can be grouped into the following categories.

Nerve injury or irritation
Prolonged hiccups can be caused by irritation or damage to the vagus or phrenic nerves that control the diaphragm. Irritation of these nerves may result from:

• when a hair or other object in the ear touches the eardrum;

• gastroesophageal reflux;

• sore throat or laryngitis;

• swelling, cyst or goiter on the neck.

Central nervous system disorders
Infections or tumors of the central nervous system, as well as damage to the nervous system as a result of trauma, can interfere with the body’s control over the hiccupping reflex. For example: encephalitis, meningitis, multiple sclerosis, stroke, traumatic brain injury, tumors.

Prolonged hiccups can also have the following causes : alcoholism, anesthesia, barbiturates, diabetes, electrolyte imbalance, kidney disease, steroid use, tranquilizers.

Risk factors

Prolonged attacks of hiccups occur in men much more often than in women. Other risk factors include:

Mental or emotional problems . Anxiety, stress and intense excitement can provoke an attack of both short-term and prolonged hiccups.

Surgical interventions. Some people have hiccups following general anesthesia or abdominal surgery.

How to get rid of hiccups quickly

Press on the root of the tongue
Touch the base of the tongue with your fingers as if trying to induce vomiting.A spasm of the esophagus will stop the contraction of the diaphragm. Unpleasant, but effective.

Eat something unusual
Put a slice of lemon on your tongue, swallow a spoonful of sugar, lick the salt: a sudden ingestion of a product with a pungent taste (sour, bitter, sweet, salty) into the stomach will trigger the secretion of gastric juice and distract the body from hiccups.

Prepare for the dive
Cover your ears with both thumbs. Close your sinuses with your little fingers.Close your eyes, to be sure, cover them with the remaining fingers. Take a deep breath and hold your breath for as long as possible. After this exercise, you will start to breathe quickly and heavily. This will allow the diaphragm to open and the hiccups will stop.

Hiccups – just a spasm of the diaphragm, but because of the strange sound, suddenness and unpleasant sensation it is not liked . And although it usually passes quickly, no one wants to wait even 15 minutes until everything is over.
There is no universal remedy – someone is helped by a spoonful of sugar on the tongue, and someone is helped by a large glass of water, drunk in one gulp.And you also need to remember – if the hiccups are prolonged, repeated often and lasts a long time, this is a reason to consult a doctor to find out its cause.

90,000 Let’s find out what causes hiccups: the main reasons how to get rid of

Every person in this life has experienced a hiccup at least once. It is an unpleasant convulsive contraction of the diaphragm that causes an attack. But what causes hiccups? Why does it appear completely suddenly? Why do the attacks sometimes last for a long time and sometimes for several minutes? We will answer these questions in more detail in this article.

Mechanical process

Speaking about what causes hiccups, you should pay attention to the fact that the occurrence of such an attack is a physiological process that appears against the background of contraction of the diaphragm. The reason for the appearance lies in the load on the so-called vagus nerve. This nerve is present in everyone in the body. It innervates the mucous membrane and throughout the body. The vagus nerve connects the central nervous system with the actions of internal organs.It is located directly in the chest, and passes through a small hole in the diaphragm into the peritoneum and to the rest of the organs.

The diagram itself consists of tendons and muscles, and its septum is too narrow. If the nerve is working properly, then it must send commands to the brain, as a result of which the diaphragm contracts, and the glottis begins to close and an unpleasant sound appears, which we call hiccups.

From what does it arise?

Experts also identify some of the reasons, factors due to which an attack occurs.In addition, you should pay attention to the fact that a symptom can occur due to various ailments. However, first you should consider the reasons why hiccups occur, which are not associated with diseases. These include:

  1. Fast food intake. The fact is that with the rapid use of food, large, unchewed pieces enter the stomach, which begin to injure and irritate the above-described vagus nerve.
  2. Severe overeating. Why does hiccups occur after eating? A large amount of food consumed can stretch the stomach, as a result of which it comes into contact with the diaphragm, thereby irritating it.
  3. Eating food in an awkward position. After eating, hiccups occur if consumed in an uncomfortable position. Experts advise to eat at the table while sitting, otherwise the nerve will contract, and the diaphragm will begin to contract convulsively. This results in hiccups.
  4. Eating dry food. Too cold or hot food, as well as drinks, dry food can lead to an unpleasant symptom.
  5. Fright. When a person is suddenly frightened of something, then he exhales sharply, which is why the diaphragm begins to irritate.
  6. Drinking carbonated drinks. When a person drinks large quantities of soda, the stomach begins to expand, which presses on the vagus nerve.
  7. Microtrauma of the vagus nerve. When a nerve is injured, the diaphragm contracts to heal the injury, which causes the hiccups to occur.
  8. Alcohol abuse. In adults, hiccups can occur due to excessive drinking.Toxins provoke an enlarged liver, muscle relaxation. This is why drunk people often hiccup.
  9. Hiccups when smoking. Such an unpleasant symptom can also occur due to smoking. Experts explain this by the fact that the sphincter is weakened, which entails the release of acid into the esophagus, irritation of the diaphragm. In addition, smokers observe poisoning by combustion products, as well as the absorption of smoke together with air.
  10. Speaking about why hiccups occur, you should also pay attention to the fact that this is due to hypothermia.In most cases, this applies to young children. The seizure being viewed may appear if a person is experiencing some kind of severe stress.

The reason is the disease

So, above we considered that the frequent hiccups are observed in most cases due to overeating or improper eating. However, there are also diseases that can trigger this symptom. If the attack lasts for more than 2 days, then it is imperative that you visit a specialist, examine the body, after which treatment will be prescribed.So, let’s consider why an adult has hiccups, from what diseases. These include:

  1. Hypermotor dyskinesia. In this case, the contents of the stomach constantly irritate the esophagus, thereby provoking attacks of hiccups. In addition, there are other symptoms: coughing, cervical muscle tension, heartburn.
  2. Hernia in the diaphragm. As a result of this diagnosis, hiccups can occur immediately after eating food and when changing the position of your body. In some cases, the symptom is accompanied by slight soreness in the sternum or in the abdomen.As a result of the development of such a hernia, internal organs begin to shift, which is why shortness of breath appears, as well as frequent heart rhythms.
  3. Abnormal lung function. In this case, in addition to hiccups, people also begin to lose hair, drowsiness and constant yawning appear.
  4. Radiculitis of the cervicothoracic region. In this case, the roots on the spinal cord are affected, the tone of the diaphragm increases, the liver shifts downward. Prolonged hiccups in this case also begins to be accompanied by discomfort in the throat, the appearance of a coma, which a person cannot swallow.
  5. Improper functioning of the central nervous system. This can occur due to a tumor, infection, trauma. What causes chronic hiccups in adults? It can be provoked by a stroke, meningitis, multiple sclerosis, encephalitis.
  6. Intracranial pressure. In this case, the hiccups are excruciating and intense.
  7. Pathology of the gastrointestinal tract. Answering the question of what causes hiccups in a person, it is imperative to mention diseases of the gastrointestinal tract.This should include gastritis, ulcers, pancreatitis, as well as various problems of the bile excretory system.
  8. Oncology. Cancer of the lungs, stomach, esophagus, pancreas, liver can provoke an attack.

If you do not know why hiccups occur in children, then the above diseases can also be accompanied by a similar symptom. That is why it is imperative not to ignore the attack, especially if it continues for a long time.

Other causes of hiccups

Other reasons why hiccups may occur should also be highlighted. They are not associated with the development of the disease. This should include chemotherapy or anesthesia. As a rule, after such manipulations, a person can hiccup for a long time and often. With some surgical interventions that are related to the respiratory system, an unpleasant symptom may also occur.

How to get rid of hiccups?

Despite all of the above reasons and factors that provoke hiccups, medicine is not able to name the specific causes of such a symptom.That is why, at the present time, there is still no universal remedy that can save a person from this scourge. However, do not be upset about this, as you can use several reliable and proven methods to solve this problem at home.

First of all, the spasm of the esophagus and diaphragm should be stopped. This can be done by holding the breath or distracting attention. In most cases, this turns out to be quite enough to combat the problem.But if hiccups occur in a person constantly, and the attack is protracted, then it is best to seek help from a specialist who should prescribe an ultrasound of the esophagus, identifying the main cause of the symptom, after which adequate treatment will be prescribed.

Below we will consider ways to get rid of hiccups that you can use yourself at home.

Reflex Method

To do this, press your finger on the base of the tongue, as if you were provoking vomiting.Thanks to the spasm of the esophagus, the contraction of the diaphragm is removed, and the hiccups recede.

Drinking water

Plain water is a very effective method. To do this, you need to drink a large glass of drinking water, but in small sips. In this way, you can remove all particles of food debris from the pharynx, as a result of which their effect on the nerve that passes in this place is eliminated. You can also drink the water by tilting your torso, pushing the glass away from you.

Sour or bitter

To get rid of hiccups, you can swallow something very sour or bitter.To do this, you can eat a spoonful of vinegar diluted with water. When the solution enters the digestive system, the cramping should stop.

Sugar

To get rid of hiccups, you can put granulated sugar on your tongue. Swallow it. You can also dissolve one tablespoon of granulated sugar in two tablespoons of beer, and then drink the mixture.

Breathing

Try to inhale deeply several times, hold your breath for the maximum time. Then exhale the air into a paper bag, and inhale, inhale from the same bag.Thanks to this, the blood is filled with carbon dioxide, and the hiccups pass much faster.

Betting on money

It may sound a little silly and strange, but this method has often helped to get rid of hiccups. If a person starts to hiccup, then take the money out of your wallet and put it on the table. Make a bet with the hiccuping person that they will stop hiccuping in a couple of minutes. Quite surprisingly, often in such situations, hiccups go away literally instantly.

Press or push-ups

If you are tormented by hiccups, then swing the press or push-ups until the attack completely leaves you.This method is effective, but it is not suitable for everyone.

Protruding tongue

If you are tormented by hiccups, try to stick out your tongue, then pull it and hold it in this position for 5-10 seconds. This method was the favorite of all to get rid of hiccups at President Kennedy’s personal physician.

In conclusion, it is worth noting that hiccups are a very unpleasant and annoying condition.