Hiccups

Hiccups Quick Overview

Hiccups are brief and involuntary contractions of the diaphragm muscle.

Irritation of the nerves that extend from the neck to the chest can cause hiccups. Many conditions can cause this irritation and result in hiccups, including eating too fast and swallowing air, chewing gum, smoking, eating or drinking too much, strokes, brain tumors, damage to the vagus or phrenic nerve, some medications, noxious fumes, anxiety and stress, and in babies, hiccups may be associated with crying, coughing, or gastroesophageal reflux (GERD).

Hiccups are rarely a cause for concern, but if hiccups become frequent, chronic, and persistent (lasting more than 3 hours), if they affect sleeping patterns, interfere with eating, cause reflux of food or vomiting, occur with severe abdominal pain, fever, shortness of breath, spitting up blood, or feeling as if the throat is going to close up, see a doctor.

There are numerous home remedies to get rid of hiccups, including holding your breath, drinking a glass of water quickly, having someone frighten or surprise you, using smelling salts, pulling hard on your tongue, and others.

For severe or chronic hiccups that are not cured with home treatment, medical treatments include medications, anesthesia to block the phrenic nerve, and surgical implantation of an electronic stimulator to the vagus nerve. Surgery to disable the phrenic nerve is a treatment of last resort.

The prognosis for hiccups is good. For most people, hiccups usually stop by themselves with no lingering effects. If hiccups continue, they may cause social embarrassment and distress, and chronic hiccups may result in speech, eating, and sleeping disorders.

What Are Hiccups?

Hiccups are sudden, involuntary contractions of the diaphragm muscle. As the muscle contracts repeatedly, the opening between the vocal cords snaps shut to check the inflow of air and makes the hiccup sound. Irritation of the nerves that extend from the neck to the chest can cause hiccups.

Although associated with a variety of ailments (some can be serious such as pneumonia or when harmful substances build up in the blood for example from kidney failure), hiccups are not serious and have no clear reason for occurring. Rarely, their presence causes health problems such as speech changes or interference with eating and sleeping.

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What Causes Hiccups?

Many conditions are associated with hiccups, but none has been shown to be the cause of hiccups.

  • If a person eats too fast, he or she can swallow air along with food and end up with the hiccups.
  • Smoking or chewing gum also can cause a person to swallow air and get hiccups.
  • Any other practices that might irritate the diaphragm such as eating too much (especially fatty foods) or drinking too much (alcohol or carbonated drinks) can make a person prone to having hiccups.
  • In these instances, the stomach, which sits underneath and adjacent to the diaphragm, is distended or stretched. As they occur in relation to eating and drinking, hiccups are sometimes thought to be a reflex to protect a person from choking.
  • Strokes or brain tumors involving the brain stem, and some chronic medical disorders (such as renal failure) are reported to cause hiccups; trauma to the brain, meningitis, and encephalitis also may cause hiccups.
  • Damage to the vagus or phrenic nerve may cause hiccups to last a long time.
  • Problems with the liver, including swelling, infection, or masses can cause irritation of the diaphragm, which can cause hiccups.
  • Some medications that can cause acid reflux may also have hiccups as a side effect. Most benzodiazepines, including diazepam (Valium), alprazolam (Xanax) and lorazepam (Ativan) can cause hiccups. In addition, medications such levodopa (Larodopa), nicotine, and ondansetron (Zofran) can cause hiccups. Other medications that can cause hiccups include levodopa, methyldopa (Aldomet), nicotine, ondansetron (Zofran), barbiturates, opioid pain relievers, corticosteroids, anesthesia, or chemotherapy medications.
  • Noxious fumes can also trigger hiccup symptoms.
  • A baby may hiccup after crying or coughing. This is common in babies in the first year. In some instances, babies with gastroesophageal reflux (GERD) could be more prone to hiccups.
  • Anxiety and stress can induce both short and long-term hiccups

What Are Symptoms of Hiccups?

Hiccups can be described as brief, irritable spasms of the diaphragm that can occur for a few seconds or minutes. They infrequently last longer in normal individuals without any underlying medical problem.

Which Types of Doctor Treats Hiccups?

Because hiccups are rarely a medical emergency, you will likely first consult your family practitioner or internist. Children may see their pediatrician.

In the case of an emergency as described above you may see an emergency medicine specialist in a hospital's emergency department.

Other specialists who may be involved in treating hiccups include an otolaryngologist (an ear, nose, and throat specialist, or ENT), a gastroenterologist (a specialist in the digestive tract), a neurologist (a specialist in the brain and nervous system), a pulmonologist (a lung specialist), or a psychologist.

When Should a Person Seek Medical Care for Hiccups?

A person should see a doctor if the hiccups become chronic and persistent (if they last more than 3 hours), or if they affect sleeping patterns, interfere with eating, or cause reflux of food or vomiting.

Hiccups is rarely a medical emergency. If hiccups last for more than 3 hours, occur with severe abdominal pain, fever, shortness of breath, vomiting, spitting up blood, or feeling as if the throat is going to close up, the person should seek medical attention.

How Is the Cause of Hiccups Diagnosed?

Diagnosis is based on physical evaluation. Laboratory testing is rarely necessary unless the hiccups are suspected to be a symptom of an associated medical condition. The tests to diagnose the associated medical condition will be done and tests will vary according to the associated condition.

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How Do I Get Rid of the Hiccups?

There are a variety of home remedies to resolve hiccups, which include holding your breath to drinking a glass of water quickly. The common thread to most of these remedies is that carbon dioxide builds up in the blood or stimulating the vagus nerve will stop hiccups. Medical care is rarely needed to cure hiccups. If a person has hiccups for more than two days, they should seek medical care.

What Home Remedies Get Rid of the Hiccups?

Numerous home remedies to stop hiccups exist. The reason these remedies are thought to work is that carbon dioxide build-up in the blood will stop hiccups, which is what happens when a person holds their breath. Stimulation of the vagus nerve (the nerve that runs from the brain to the stomach) is stimulated, hiccups can also be alleviated (this is what is happening when a person drinks water or pulls on their tongue).

Try these methods at home to get rid of the hiccups:

  • Hold your breath.
  • Drink a glass of water quickly.
  • Have someone frighten you (or better, surprise) the person
  • Use smelling salts.
  • Have the person pull hard on their tongue.
  • Place one-half teaspoon of dry sugar on the back of the tongue. (Repeat this process 3 times at 2-minute intervals, if necessary use corn syrup, not sugar, in young children.)

There are many other suggestions to get rid of the hiccups such as "name 10 famous bald men;" "stick a finger in the ear;" tickling the palate with a swab; or swallowing a tablespoon full of honey (this distracts the person with the hiccups and may help the diaphragm relax). However, a person should only try those methods they are comfortable, and be aware that some methods are not suitable for infants (honey, sugar methods), elderly with swallowing problems, and others with health problems. Call your doctor for further information if individuals have any questions about home remedies or if they fail to stop the hiccups.

What Is the Medical Treatment for Hiccups?

Treatment for getting rid of the hiccups depends on how severe the hiccups are.

  • For the common hiccups that will usually stop on their own, home remedies are generally sufficient to cure the symptoms.
  • For more severe, persistent hiccups (usually lasting over to 2 days), the doctor may try medications to manage the patient's hiccups. Chlorpromazine (Thorazine) is usually the first prescription medication tried for hiccups, although drugs such as baclofen (Lioresal) and medications for convulsions such as phenytoin (Dilantin) have also been successful.
  • Anesthesia to block the phrenic nerve and surgical implantation of an electronic stimulator to the vagus nerve has been effective. Surgery to disable the phrenic nerve (the nerve that controls the diaphragm) is often the treatment of last resort.

What Is the Outlook for a Person Who Has the Hiccups?

In healthy people, hiccups usually go away by themselves with no serious effects after that. If hiccups continue, however, they may cause social embarrassment and distress, and if prolonged may result in speech, eating, and sleeping disorders.

Reviewed on 9/15/2017

REFERENCE:

Wilkes, G. "Hiccups." Medscape. Updated: Dec 20, 2016.
<http://emedicine.medscape.com/article/775746-overview>

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