December 16, 2018
Hiccups That Don\
Ask Berkeley Wellness

Hiccups That Don't Go Away

by Jeanine Barone  

Q: I get hiccups that sometimes last for hours or even days. What’s that about? And how can I get rid of them?

A: Though not common, it’s possible for bouts to last that long—or even longer. Singultus is the medical name for hiccupping (from the Latin noun meaning convulsive catching of breath, sobbing, or gasp), which is a reflex—and a complex one at that, involving many structures, including the phrenic and vagus nerves.

The mechanism hasn’t been entirely explained, but a hiccup basically occurs when the diaphragm and the intercostal muscles (those between the ribs) involuntarily contract, followed by a sudden inhalation of air and then an abrupt closure of the glottis (the opening between the vocal cords in the larynx). The result is the characteristic “hic” sound. The rate at which a person hiccups varies by individual, but it generally ranges from four to 60 per minute.

Usually, hiccups last only a short time (called acute hiccups), blamed on such things as eating too much or too fast, swallowing air while chewing gum, or drinking carbonated sodas, all of which can distend the stomach, thereby irritating the nerves running from the abdomen to the brain. Fatty or spicy foods, heavy alcohol drinking, and hot or cold beverages that suddenly change the temperature of the stomach may also affect the hiccup reflex pathway.

Bouts that last between 48 hours and one month are called persistent hiccups; those that occur for more than a month are called intractable. Such prolonged hiccups not only are distracting and uncomfortable, but also can lead to insomnia, fatigue, mental stress, and eventually even dehydration, weight loss, and malnutrition. It’s estimated that some 4,000 people in the U.S., mostly men, are hospitalized annually because of severe hiccups. At least one death has been reported.

Getting rid of hiccups

People swear by all kinds of home hiccup remedies—such as holding their breath or taking a deep inhalation, sipping cold water (which stimulates the uvula, the fleshy structure that dangles at the back of the mouth), or leaning forward from the waist or pulling knees to chest (which press on the diaphragm). Though none are proven, they are harmless and may work by inhibiting the nerve impulses involved in the hiccup reflex, or by altering normal breathing. Or the remedies may seem to work simply because the hiccups stop on their own.

Among the alternative therapies promoted for prolonged hiccups are hypnosis, acupuncture, and near-infrared radiation to acupressure points, but here, too, the evidence for benefit is uncertain.

Hiccups that don’t resolve on their own or with any of the above measures require medical evaluation to determine the cause since they may indicate a more serious medical problem, such as infection, kidney failure, a tumor, or a stroke. Other causes include GERD (gastroesophageal reflux disease) and certain drugs, including those used to treat Parkinson’s disease and chemotherapy. Or they may be related to anxiety and stress.

If no cause is found or if the hiccups continue despite treatment of an underlying condition (such as GERD), drugs may be an option. First-line therapy can be either gabapentin (an anti-seizure drug) or baclofen (a muscle relaxant). Chlorpromazine, an antipsychotic, is the only drug approved by the FDA to treat hiccups, but it is no longer considered the first choice because of potentially serious side effects. If absolutely everything fails, a last resort is surgery, including partially cutting the phrenic nerve.

Also see 6 Body Oddities Explained.