Hiccups: Causes, Types, & Treatments.
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
Types of Hiccups.
Hiccups occur due to sudden contraction of the muscles responsible for inspiration (mainly the diaphragm). The exact cause and benefits of hiccup bouts that happen to almost everyone are still not known.
Hiccups occur in infants inside the uterus before birth. One theory suggests that hiccups may help prepare the fetus’s respiratory muscle for future respiration after birth (reference).
A supporting fact for this theory is that pre-mature infants spend 2.5% of their time hiccuping (reference).
Two main types of hiccups according to the duration:
- Acute Hiccups (hiccup bouts): attacks of hiccups that last for minutes or hours (not exceeding 48 hours).
Acute hiccups are very common; they are often not caused by a serious disease.
- Chronic (interactable) hiccups: it lasts more than 48H (often for more than a month). This type of hiccup is secondary to chronic diseases and conditions (either psychological or organic diseases).
Acute Hiccups (bouts).
Chronic Hiccups ( more than 48 hours).
|Attacks of hiccups last for a short time (often minutes).||Persistent hiccups can treatment days or months.|
|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.|
- How Long Do Hiccups Last? 7 Scenarios Explained.
- 5 Emotional (Psychological) Causes of Hiccups & How to recognize them.
1. Acute Hiccups (hiccup bouts):
- The most common pattern of hiccups.
- Not caused by severe diseases.
- Men are typically affected more than women (reference).
- Common in “TALL” persons! (reference).
- Causes are simple as over-eating over-drinking ofoalcohols or carbonated drinks.
- They resolve on their own within a few minutes.
2. Chronic (persistent or intractable) hiccups:
- It lasts for more than 48 hours.
- It is often a symptom of a severe physical or psychological disease.
- It may interrupt your eating, drinking, sleeping, or even conversations.
- Persistent hiccups may also cause insomnia, fatigue, and mental stress (impairing your quality of life).
The causes of chronic or persistent hiccups are in the table below (reference):
1. Digestive system
|– Gastric distension (overeating, carbonated drinks, aerophagia).|
– 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/ M2etabolic.
– 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 ear canal (irritation of eardrum).
– Enlarged thyroid gland (goiter).
– Neck cysts or neck tumors.
6. Drugs that cause Hiccups
|– Chemotherapy (as carboplatin).|
– Some anti-hypertensive drugs as Alphamethyldopa.
– Sedativesosuch as Barbituratesoandodiazipam.
|– Anorexia Nervosa.|
– Post-traumatic stress disorder.
– Extreme excitement, stress.
– Schizophrenia, conversion reactions.
8. After operations
|– General Anaesthesia (anesthetic medications affect digestive system motility).|
– InsertT.B. of an endotracheal tube (during general anesthesia).
|– Myocardial infarction.|
– Inflammation of the membrane surrounding your heart (pericarditis).
– Access under the diaphragm (subphrenic abscess).
– Malaria, T.B, Herpes Zoster, and Covid-19 (reference).
The most common causes of persistent hiccups are:
- Brain stroke.
- Throat inflammation (pharyngitis).
- Psychological diseases.
- Enlarged thoracic lymph nodes.
- Renal failure.
- Enlarged thyroid gland (goiter).
Treatment of Hiccups.
A. treatment of Hiccup bouts (<48 Hours).
1. NO Treatment.
Acute hiccups are often self-limiting, it may last for a few minutes then resolve on their own.
2. Physical Methods:
Prevention of Co2 from leaving your lungs helps to terminate acute hiccups (reference). Also, techniques that irritate your nasopharynx and uvula, increase vagal stimulation, or relieve diaphragmatic irritation help stop hiccups.
These methods are safe and can be effective within seconds or methods. They have no Side effects.
The list of physical techniques that relieve acute hiccups are in the table below:
|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 terminate hiccups.
NOTE: There are no Randomized clinical trials that confirm the efficacy of the above methods. Small observational studies or case reports only suggest them. However, They are safe to use and can be effective.
B. Chronic or prolonged hiccup treatment.
1. Define the cause.
Hiccups that continue for hours require you to consult your doctor. Simple or acute hiccups are occasional findings in most people. However, prolonged hiccups often reflect a disease (See the list of causes above).
So, Treatment of prolonged hiccups is essentially identification and treatment of the original cause. You cannot diagnose the cause of chronic hiccups by yourself.
You should see a doctor, so he can:
- Take a thorough medical history.
- Perform a physical examination.
- Request any necessary laboratory or imaging investigations.
Your doctor will perform the required three steps to identify the cause. Then, he will plan for the treatment (For example, Treatment of pharyngitis will improve hiccups).
2. Physical methods (temporary solution).
Physical methods such as breath holding, Valsalva maneuver, and others (discussed above) may help reduce chronic hiccups.
You can use them as safe remedies for hiccups while waiting for the investigations or your doctor’s appointment.
3. Medications to stop hiccups.
Often, your doctor will prescribe drugs to control hiccups that last for more than 48 hours. Medications are necessary for almost all cases of persistent hiccups unless there is an apparent cause that can be cured (such as a Foreign body inside your ear).
Examples of drugs that can help persistent hiccups (the majority are prescription drugs):
|1. Baclofen||– A muscle relaxant that is originally used 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.
Notes on Treatment of persistent Hiccups.
- Medications are important to stop persistent hiccups, However, identifications and treatment of the cause are more important.
- Your doctor will start with one or more of the first-line medications (Baclofen, Metoclopramide, and gabapentin).
- These first-line medications are often prescribed for 5 to 10 days.
- If there is a good response, your doctor will discontinue the drug. However, if Hiccup recurs after stopping the medication, your doctor may prescribe them for longer periods.
4. Other treatments for refractory hiccups:
- Adjustment of the medications or combining more than one drug.
- Implantation of a vagus nerve stimulator.
- Phrenic nerve blocking.