What are hiccups?
Hiccups, also referred to as hiccoughs or singultus, are brief, involuntary spasms or contractions of the diaphragm muscle. The diaphragm is a dome-shaped muscle beneath your lungs that plays a key role in both inhalation and exhalation. When hiccups strike, these three events occur in quick succession: 1. the diaphragm muscle contracts abruptly 2. the larynx (voice box) tightens simultaneously 3. the epiglottis snaps shut rapidly
When these events coincide, you hear the signature “hic” sound characteristic of hiccups. Almost everyone will experience hiccups at some point in their life. They are generally harmless and typically fade on their own within a few minutes.
What causes hiccups?
The precise underlying cause of hiccups remains somewhat unclear. They seem to arise when the diaphragm is irritated or stimulated in some fashion. Various factors that may trigger hiccups include:,
- eating too quickly or overeating
- consuming hot or spicy foods
- drinking excessive alcohol
- carbonated beverages
- hot drinks
- indigestion
- stress, fear, or excitement
- irritated stomach
- smoking
- swallowing air, especially when chewing gum or sucking candy
- pregnancy
What about persistent hiccups?
Although hiccups typically subside within minutes, on rare occasions they can persist for two days or longer. These prolonged bouts, called persistent or chronic hiccups, often point to an underlying injury, health problem, or medication effect. Several health issues can trigger ongoing hiccups:,
- Gastro-oesophageal reflux (GORD) or heartburn
- Oesophagitis (inflammation of the oesophagus)
- Pneumonia
- Pleurisy
- Asthma
- Chronic kidney disease
- Recent chest or abdominal surgery
- Hyperthyroidism
- Brain injury from stroke, tumour, or trauma
- Central nervous system disorders (e.g. multiple sclerosis, stroke)
- Diabetes
- Irritation or damage to the phrenic nerve, caused by:
1. sore throat or laryngitis 2. tumour, cyst, or goitre 3. acid reflux 4. a foreign particle touching the eardrum
Certain drugs are also linked to chronic hiccups:
- Anaesthetics
- Corticosteroids
- Chemotherapy agents
- Medications for anxiety, hypertension, pain, and seizure control
Complications of hiccups
Though hiccups are generally a brief nuisance that resolve independently without lasting effects, when they continue unabated they can lead to complications such as:
- Fatigue
- Unintended weight loss
- Malnutrition
- Insomnia
- Psychological distress (e.g. anxiety or depression)
- Gastrointestinal issues, including vomiting
When should you seek medical attention?
If hiccups persist beyond 48 hours, you should consult your doctor to identify any root cause. You should also seek help if hiccups interfere with eating, breathing, or sleep, or if they cause significant distress. To investigate further, your physician may order diagnostic tests such as:
Physical neurological exam
Physical neurological examination, a detailed assessment of balance, coordination, muscle power, tendon reflexes, and sensory function.
Laboratory tests
Laboratory tests, comprehensive blood analyses, including complete blood count and metabolic screening, to uncover infections, diabetes, kidney dysfunction, or other systemic disorders.
Imaging studies
Imaging studies, diagnostic imaging such as chest X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) to visualize the diaphragm, phrenic nerve tracks, and surrounding thoracic structures for any anomalies.
Endoscopic evaluation
Endoscopic evaluation, a slender, camera-equipped endoscope is guided through the mouth into the oesophagus and windpipe to directly observe any inflammation, obstruction, or lesions.
Persistent or chronic hiccups may require active intervention:12,13
Such as:
- addressing the root cause or disorder
- modifying current medications and dosages
- prescribing drugs such as tranquillisers, muscle relaxants, anticonvulsants, or stimulants
- non-pharmacological options like acupuncture or guided physical manoeuvres
- nasogastric tube placement
- nerve block of the phrenic or vagus nerve
- surgical division of the nerve supply to the diaphragm
You may then be referred to a specialist, such as a gastroenterologist or neurologist, for further care.
What can you do?
Most hiccups stop on their own, but you can try home remedies that lack strong scientific backing. Numerous anecdotal “cures” circulate online, though clinical validation is limited. While results can vary, these techniques are easy, low-risk, and worth a try. Strategies recommended include:
- drinking cold water in small sips
- holding your breath, then exhaling slowly when you can’t continue
- breathing deeply into a paper bag
- sipping hot water mixed with honey
- gargling plain water
- sitting forward with your head between your knees
- having someone startle you unexpectedly