Constant Hiccups: Causes, When to Worry, & Treatment.
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What are constant hiccups?
A (Constant hiccups) is not a medical term. However, people use the word (constant) to describe different patterns of hiccups such as:
- Recurrent hiccups bouts: recurrent attacks of acute hiccups, each lasting for less than 48 hours.
- Persistent hiccups: hiccups that last for more than 48 hours but less than one month.
- Intractable hiccups: intractable hiccups are hiccups lasting for more than one month.
Depending on your pattern of hiccups, constant hiccups can fall to any of the three categories above.
Generally speaking, Acute hiccups that last for less than 48 are considered simple and often go away independently. But hiccups lasting for more than 48 hours (either persistent or intractable) usually signify a disease.
The fundamental differences between acute and chronic hiccups are in the table below:
Acute Hiccups (bouts).
Chronic Hiccups ( more than 48 hours).
|Attacks of hiccups last for a short time (often minutes). Constant hiccups that last less than 48 are considered acute hiccups.||Constant hiccups lasting for more than 48 hours are considered (chronic).|
|Occurs in healthy individuals.||Occurs secondary to disease.|
|Resolve spontaneously.||Often requires treatment (anti-hiccup treatment plus treatment of the cause).|
|Commonly due to gastric distension (overeating, carbonated drinks, swallowing of air).||Reflects serious conditions such as chronic digestive system, chest, or brain disease.”|
|No need to see a doctor.||Consult your doctor.|
1. Constant hiccups lasting for less than 48 hours (acute hiccups).
Hiccups occur to almost everyone. Typically, people experience brief attacks of hiccups lasting for a few minutes.
However, hiccups may persist and become constant for several hours. Therefore, any hiccups lasting for less than 48 hours are considered acute hiccups (even if they’re constant for long hours).
Frequent hiccup bouts lasting for short periods are often benign. The common triggers include:
- Stomach distension (Overeating or over-drinking): that is why many people get constant hiccups after eating.
- Carbonated drinks: the released gas inside your stomach leads to severe distension, which triggers hiccups.
- Drinking alcoholi.
- Eating Too quickly (leads to swallowing of air and stomach distension).
- Sudden temperature changes.
- Swallowing too much air.
Moreover, Newborn infants and babies tend to have constant hiccups after breastfeeding. The research found that the average infant spends about 2.5% of his time hiccups.
There is no need to worry about constant or recurrent hiccups in young babies unless they become prolonged for days or constantly interfere with their feeding, sleep, or respiration.
2. Constant hiccups lasting for more than 48 hours.
Hiccups that become constant for more extended periods are considered chronic. Chronic hiccups often require medical evaluation by a doctor.
Constant hiccups may reflect a disease or a condition affecting the hiccups reflex arch. The hiccups reflex arch consists of:
- Hiccup-producing muscles: mainly the diaphragm and the intercostal muscles.
- Nerves: mainly the vagus and phrenic nerves.
- The brain centers (responsible for hiccups).
Too many causes of hiccups are present. They cause hiccups by a variety of mechanisms. However, the irritation of the vagus nerve is considered the main trigger.
The leading causes of constant (chronic) hiccups are in the table below:
Causes of Chronic Hiccups.
|1. Digestive system||– Gastric distension|
– Chronic gastritis and peptic ulcer disease.
– GERD and esophagitis.
– Stomach or esophageal cancer.
– Pancreatitis and pancreatic cancer.
– Gallbladder diseases (as gallstone disease).
– Inflammatory bowel disease, Bowel obstruction.
|2. Toxic/ Metabolic.||– Alcoholi abuse.|
– Diabetes Mellitus.
– Renal failure.
– Hypocalcemia, Hyponatremia (↓ sodium).
|3. Neurological diseases||– Cerebral stroke.|
– Severe head trauma.
– Brain tumors.
– Multiple sclerosis.
– Infections (brain abscess, meningitis, encephalitis).
– Malformation of brain blood vessels.
– Inflammations of the vessel wall (as temporal arteritis)
|4. Diseases in the chest||– Pneumonia, bronchitis.|
– enlarged lymph nodes around the esophagus (mediastinal LNs).
– Bronchial asthma.
– Inflammation of the lung envelope (pleurisy) or pus (empyema).
– Tumors and trauma of the mediastinum.
|5. Vagus & phrenic nerve irritation||– Pharyngitis and laryngitis.|
– FB or hair inside the air (irritation of eardrum).
– Enlarged thyroid gland (goiter).
– Neck cysts or neck tumors.
|6. Drugs that cause Hiccups||– Chemotherapy (as carboplatin).|
– Corticocorticosterioids(as dexamethasone).
– Some anti-hypertensives such as Alphamethyldopa.
– Sedativesosuch as Barbituratesoandodiazipam.
|7. Psychogenic||– Anorexia Nervosa.|
– Post-traumatic stress disorder.
– Extreme excitement, stress.
– Schizophrenia, conversion reactions.
|8. After operations||– General Anaesthesia (anesthetic medications affect digestive system motility).|
– Insertion of the endotracheal tube (during general anesthesia).
|9. Others.||– Myocardial infarction.|
– Inflammation of the membrane surrounding your heart (pericarditis).
– Access under the diaphragm (subphrenic abscess).
– Malaria, TB, Herpes Zoster, and Covid-19 (reference).
3. When to see a doctor for constant hiccups
Simple attacks of hiccups lasting for minutes (often after eating) are considered benign. Also, they are frequent in newborns and young infants. No need to see a doctor unless:
- Hiccups become very frequent (all day on and off) for several days.
- Constant hiccups for more than 48 hours.
- Hiccups that interfere with your sleeping.
- Hiccups constantly interfere with your eating or breathing.
Constant hiccups need a thorough evaluation and investigation by your doctor. First, a cause has to be defined for prolonged hiccups. In addition, A treatment of the cause often results in the resolution of hiccups.
4. Simple techniques that help hiccups relief.
You can try one of the techniques below that can help the resolution of hiccups. However, constant hiccups may need a medical evaluation and prescription medication.
Learn More: how to stop hiccups instantly at home.
|1. Breath Holding||Hold your breath for ten or more seconds (or as long as you can).|
|2. Valsalva Maneuver||– Pinch your nose closed and close your mouth.|
– Forcefully exhale with mouth closed.
– Bear down (similar to having a bowel movement).
– Hold this exhalation/Bearing down for 10-15 seconds.
|3. Coldwater.||Either sipping on or gurgling with freezing water.|
|4. Lemon.||– Bitting into a lemon.|
|5. Tongue Pulling.||– Pull your tongue out with your fingers (stimulates the vagus nerve).|
|6. Pressing on eyeballs.||– Close your eyes.|
– Make your eyeballs look downwards while closed.
– Press gently but firmly on your eyeball (over the upper eyelid).
|7. Knee-chest Position.||– Sit on a chair or a couch.|
– Either pull your knees up to the chest OR lean forward to compress your chest with your things).
– Hold this position for at least 30 seconds to one minute.
|8. FISST (forced inspiratory suction and swallow tool) (reference)||– Using a specialized tool (FISST or hiccup-relieving apparatus).|
– A special tube with a valve is used to suck water (requires significant effort).
– Then, Swallowing of the water sucked from the tube.
– Note: Sucking stimulates the (phrenic nerve), while swallowing stimulates the (vagus nerve). Both help the termination of hiccups.
Constant or chronic hiccups may not resolve with the above techniques. Your doctor may prescribe medications that improve constant hiccups.
The list of medications that may help constant hiccups are in the table below (mainly, they are prescription medications):
|1. Baclofen||– A muscle relaxant that is used initially to relax spasmed muscles.|
– It can help relax the diaphragm and respiratory muscles that cause the hiccups.
|2. Metoclopramide||– An anti-emetic medication that can help with hiccups.|
|3. Gabapentin||– The drug is originally used for fits and neuropathic pain.|
– It was found to be effective in persistent hiccups.
|4. Chlorpromazine||– An anti-psychotic and anti-migraine drug.|
– It is very effective against chronic resistant hiccups.
– However, its use is limited by side effects (not preferred in the elderly).
|5. Others||– PPIs as omeprazole in refractory hiccups due to GERD or gastritis.|
– Valproic Acid.
– Nifidipine or Mimdipine.