A hiccup is an involuntary, rhythmic, and spasmodic contraction of the diaphragm (a thin dome-shaped muscle below the lungs that helps respiration), the intercostals muscles, and respiratory organs. It is accompanied by the abrupt closure of the glottis of the larynx, which produces the typical gulping sound.

This sudden contraction of the diaphragm sucks air into our lungs quickly and closes the epiglottis (the apex of the windpipe), thus making the typical ‘hic’ sound.

Usually, hiccups are temporary lasting for a few minutes, they are harmless, and can occur to anyone at any age. However, those that are prolonged and persistent can be a sign of a major medical condition.

Women and men tend to get hiccups equally, but those that last for more than 48 hours are more common in men. They are known to occur in adults, children, babies, and even in a fetus while still inside the uterus.

A hiccup may result from eating a large meal, after drinking alcoholic or carbonated beverages, or from sudden excitement.

A bout of hiccups generally resolves on its own in a few minutes or a couple of hours without intervention, although many people often employ home remedies to stop them. Medical treatment is sometimes required in chronic and persistent cases.

Symptoms

Hiccups are characteristic and clearly identifiable. They often start without any apparent reason and usually subside on their own in a few minutes.

Those that persist for a longer period may cause exhaustion due to lack of sleep, and weight loss due to the interference they cause during meals.

Other symptoms include:

  • You feel a sharp spasm of the diaphragm just below the breastbone.
  • There is involuntary suction of air into your throat.
  • There is the “hic” sound made by the closing of the epiglottis
  • Hiccups usually stop after a few minutes or a couple of hours.
  • At times, they can be chronic or persistent. Chronic ones are those that recur and last for a prolonged period. Persistent hiccups last for more than two days but less than a month. Rarely, intractable hiccups may persist for more than a month or they may often recur frequently over a long period.

Why do you get hiccups?

Hiccups are caused by the abnormal, spasmodic, and involuntary movements of the diaphragm. The phrenic nerve, which innervates the diaphragm, controls how the diaphragm moves to help in respiration.

Hiccups occur when a particular trigger stimulates the phrenic nerve and sends the diaphragm into recurring spasms. We don’t know yet how this happens, though at times there may be no triggers.

Triggers that can initiate hiccups

Various triggers, predominantly those that exert pressure on the diaphragm, can set off a series of hiccups. Some of these triggers include:

  • Eating food too hurriedly
  • Eating hot or spicy foods
  • Acute indigestion
  • Drinking carbonated drinks
  • Smoking cigarettes

Why do you get hiccups after eating, drinking, and during pregnancy?

  • Eating too much (fatty or spicy foods, in particular) or drinking too much (carbonated beverages or alcohol) can distend the stomach and cause irritation of the diaphragm, which can cause hiccups.
  • Too much alcohol – drinking even a little alcohol irritates the esophagus and stomach and triggers your stomach to produce more acid than usual, which can cause gastritis (the inflammation of the stomach lining) and a flare-up of acid reflux. This triggers hiccups.
  • Mental stress – When you are under severe stress and anxiety, you tend to hyperventilate. This can cause short-term or long-term hiccups.
  • Pregnancy – Some pregnant women have hiccups all day and all night. Their biggest cause during pregnancy is nausea and indigestion. During pregnancy, you tend to eat more due to the craving for food. Secondly, pregnancy does cause stressful times and that could also be the reason why you get hiccups.

Causes of persistent hiccups

Persistent hiccups are those that last for more than two days but less than a month. They usually have a pathological cause and can be a sign of a serious medical condition. It can be nerve damage or a central nervous system disorder or may be due to metabolic disturbances or drugs.

However, such long-lasting hiccups are very uncommon – occurring in about 1 in 100,000 people.

Phrenic or vagus nerve irritation

  • Something in your ear touching your eardrum irritates the phrenic nerve. It could even be your scalp hair or hair that grows on your ear lobes.
  • A space-occupying lesion such as a tumor, cyst, or goiter in your neck
  • Gastroesophageal reflux disease (GERD)
  • Pharyngitis or laryngitis

Central nervous system conditions

The central nervous system (CNS) comprises the brain and spinal cord. A tumor, infection, or damage due to trauma in your central nervous system can disturb the regulation of the hiccup reflex. Examples of such CNS conditions, which can cause hiccups include:

  • Encephalitis – infection in the brain
  • Meningitis – infection in the membranes covering the brain
  • Multiple sclerosis – an autoimmune chronic disease affecting the brain and the spinal cord
  • Stroke – A stroke, also known as a cerebrovascular accident (CVA) develops when there is loss of blood supply to a part of the brain.
  • Brain injury due to trauma
  • Tumor or growth

Metabolic causes

  • Diabetes
  • Kidney disease
  • Electrolyte imbalance

Drugs that cause hiccups

  • Steroids
  • Barbiturates
  • Tranquilizers

How do you stop or get rid of hiccups?

Most hiccups stop on their own. The benign ones that are due to some minor unspecified cause can be stopped by resorting to simple home remedies. If those don’t stop you should see your health provider who will put you on medication that will give you relief.

Hiccups with serious underlying medical causes should be investigated and treated accordingly.

Firstly, most hiccups stop on their own. If they persist, you could try a few homemade remedies that will stop them.

Home remedies

Home remedies retain carbon dioxide in the body, which relaxes the diaphragm and stops its spasms and subsequently the hiccups.

  • Breathe into a paper bag.
  • Drink water from the opposite side of the glass.
  • Sit down with your knees up to your chest and lean forward.
  • Sip ice-cold water.
  • Hold your breath for a short time.

Drugs to get rid of hiccups

The following treatments are usually considered for hiccups that have lasted longer than 24 hours. Before starting treatment, your doctor will ask you for details about the history of your problem. He will explore any symptoms you may have to rule out any medical condition that may be causing this disorder.

Drugs that are used to treat long-term hiccups include:

Baclofen. According to JPSM, baclofen is the most effective treatment to stop hiccups of any origin.

Chlorpromazine. Chlorpromazine is the only medication approved to treat hiccups by the US Food and Drug Administration and has been the drug of choice for many years.

Metoclopramide, a dopamine antagonist, has shown potential for stopping hiccups and reducing frequency by depressing the central nervous system.

Surgery

If the above home remedies and drugs do not work in controlling the hiccups, your health provider will recommend a right-sided ultrasound-guided phrenic nerve block with 5 ml of bupivacaine 5 mg/ml with epinephrine – a single shot injection of the anesthetic into the phrenic nerve.

Another option that Mayo clinic suggests is to surgically implant a device that works on a battery and which will deliver mild electrical stimulation to your vagus nerve to stop the hiccups.

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