Hiccups

Hiccups can be prevented by avoiding overeating, eating too quickly, or drinking too much.

A hiccup is a sudden, involuntary contraction (spasm) of the diaphragm muscle. When the muscle spasms, the vocal cords snap shut, producing the hiccup sound. Most cases of hiccups can be cured or resolved in a short time, and rarely are they a medical emergency. See your doctor if hiccups last more than three hours, or if they disturb your eating or sleeping habits.

Most of the time, there is no obvious cause for hiccups. However, there are some common known causes of hiccups.

Some causes of hiccups include:

• Eating too quickly and swallowing air along with food.
• Eating too much (fatty or spicy foods, in particular) or drinking too much (carbonated beverages or alcohol) can distend the stomach and irritate the diaphragm, which can cause hiccups.
• Any disease or disorder that irritates the nerves that control the diaphragm (such as liver disease, pneumonia, or other lung disorders).
• Abdominal surgery can also irritate the nerves that control the diaphragm, causing hiccups.
• Strokes or brain tumors involving the brain stem, and some chronic medical disorders (such as renal failure) have also been reported to cause hiccups.
• Noxious fumes can also trigger hiccups.
• Sudden changes in temperature
• Fear or excitement

Some medications may also have hiccups as a side effect, for example:

• Medications for acid reflux
• Most benzodiazepines, including diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan)
• Levodopa, nicotine, and ondansetron (Zofran)

Sudden, forceful movement of the diaphragm, that causes the hiccup sound, is the only symptom of hiccups.

Most cases of hiccups resolve themselves in a short time and rarely are a medical emergency. See your doctor if hiccups last more than 3 hours, or if they disturb your eating or sleeping habits.

Seek medical attention if hiccups are associated with the following:

• Abdominal pain
• Fever
• Shortness of breath
• Vomiting
• Coughing up blood
• Feeling as if your throat is going to close up

Most of us know what a hiccup feels like and how to recognize it. In a medical setting, the diagnosis of hiccups is based on the physical evaluation. Blood tests or X-rays are usually not necessary unless your hiccups are a symptom of an associated medical condition.

Which specialties of doctors treat hiccups?

Hiccups generally go away on their own and do not require medical treatment, however, if hiccups last more than three hours or disturb eating or sleeping, you may see your primary care provider (PCP) such as a family practitioner, internist, or a child’s pediatrician.

There may be many different specialists who treat hiccups depending on the underlying cause, for example:

• If the cause is a stroke or other neurological disorder, you may see a neurologist (a specialist in the nervous system and brain).
• If the cause is acid reflux, you may see a gastroenterologist (a specialist in disorders of the digestive system).
• If the cause is lung disease or pneumonia, you may see a pulmonologist (a specialist in disorders of the respiratory tract).

Most hiccups will stop on their own. Home remedies are generally sufficient to resolve hiccups.

For persistent hiccups (lasting more than three hours), treatment varies, and you may need to contact your doctor.

• A "hiccup bout" is an episode of hiccups that lasts up to 48 hours
• "Persistent hiccups" continue for more than 48 hours, up to 1 month
• "Intractable hiccups" last longer than 1 month

A healthcare professional may prescribe medications for severe, chronic hiccups. Chlorpromazine (Thorazine) is usually the first-line medication prescribed for hiccups. Other medications used to treat hiccups include haloperidol (Haldol) and metoclopramide (Reglan).

Some muscle relaxants, sedatives, analgesics, and even stimulants have also been reported to help alleviate hiccup symptoms.

Phrenic nerve surgery (the nerve that controls the diaphragm) is a treatment of last resort. This treatment rarely is performed, and phrenic nerve surgery is used only in individuals with long-term hiccups that do not respond to other treatments.

Home remedies for hiccups

There are numerous home cures for hiccups. You can try these methods at home to get rid of hiccups.

Techniques that stimulate the nasopharynx and the vagus nerve, which runs from the brain to the stomach, and can decrease hiccuping:

• Gargling with water
• Putting a cold compress on your face
• Breathing into a paper bag
• Blowing up a balloon
• Drink a glass of water quickly
• Have someone frighten you
• Pull hard on your tongue
• Bite on a lemon
• Gargle with water
• Drink from the far side of a glass
• Taking deep, slow breaths
• Sitting down and pulling your knees to your chest for one minute
• Use smelling salts
• Place a one-half teaspoon of dry sugar on the back of your tongue (this process can be repeated three times at two-minute intervals. Use corn syrup, not sugar, for young children)

As in adults, hiccups in newborns, infants, and babies are common and generally of no concern. If hiccups occur during feeding, stop feeding until the hiccups go away. Usually, the hiccups will "go away" in an infant or baby. You may try changing the position of the infant or baby; try to get your baby to burp, or calm him/her down to cure the hiccups. Sometimes resuming feeding will stop the hiccups. If your baby frequently has hiccups during feedings, feed your baby when he or she is already relaxed and is not overly hungry yet.

If your child's hiccups worsen or they seem to upset him, contact your pediatrician.

Because most cases of hiccups resolve themselves either spontaneously or with self-administered treatment, complications are extremely rare.

• In severe and persistent cases, where hiccups disturb eating and sleeping patterns, weight loss, or sleep disturbances may occur.
• Rarely, cardiac arrhythmias and gastroesophageal reflux disease (GERD and GER) have been noted in severe cases of hiccups.

Hiccups cannot always be prevented. Avoiding overeating, eating too quickly, or drinking too much can help prevent hiccups.