Chris Iliades, MD is a regular contributor to Bottom Line Health. He was an ear, nose, throat, head, and neck surgeon before becoming a full-time medical writer.
If you follow celebrity news, you may have learned about sports superstar Bo Jackson’s health ordeal. Bo, who survived professional baseball and football, was laid low by hiccups that lasted for a year.
Hiccups lasting less than 48 hours are called acute. Those lasting longer than 48 hours are called persistent, and those that persist for more than one month are called intractable.
Every year, about 4,000 people are admitted to the hospital with long-term, persistent, or intractable hiccups.Long-term hiccups make it hard to eat, drink, sleep, and talk. Complications may include weight loss, malnutrition, dehydration, and depression. Long-term hiccups may also be a red flag for a more serious condition like esophageal cancer or aortic aneurysm.
Anyone can get hiccups at any age They can even be seen on prenatal ultrasound exams. Men are more likely to get hiccups than women, and elderly men are at the highest risk.
The medical term for hiccups is singultus, which is a Latin word that means catching your breath while sobbing. Being sad has nothing to do with hiccups, but swallowing air while sobbing does. A laughing fit also causes swallowing air.
A hiccup is a surprisingly complex interaction of several nerves that supply your diaphragm and your vocal cords. The nerves that supply the diaphragm (the vagus and phrenic nerves) run between the muscles of your neck and past your heart and stomach. Anything that stimulates or irritates the nerves, including a belly distended with air, can trigger a sudden and involuntary contraction of the diaphragm. That reaction triggers a nerve that makes the vocal cords snap shut, causing the “hic” sound of a hiccup. This type of nerve interaction is called a reflex arc.
Smoking and chewing gum may also cause you to swallow air, called aerophagia. Other common causes of acute hiccups that interrupt the reflux arc include:
Long-term hiccups are caused by a long-term condition. It could be a problem in the throat, chest, or part of the brain that controls breathing or swallowing. Probably the most common cause is long-term heartburn, called gastroesophageal reflux disease (GERD). Ten percent of people with GERD have frequent hiccups.
Another common cause is a medication reaction. Common medications that cause hiccups include steroids, cancer chemotherapy, and sedatives. Other causes can include:
Sometimes the cause of long-term hiccups is obvious, such as cancer treatment or a diagnosis of Parkinson’s disease. But in other cases, it may be necessary to have imaging studies of the head, neck, or chest. Looking down the throat with a flexible scope, called endoscopy, is often helpful.
Treatment for long-term hiccups may include treating the cause or discontinuing a medication, but stopping the hiccups is the first goal.
There is only one drug approved to treat hiccups. It is a drug usually used to treat mental health disorders called chlorpromazine (Thorazine). Other drugs may also be used, including muscle relaxants, antiseizure medications, and metoclopramide, a drug often use to treat GERD, nausea, or vomiting.
An alternative or complementary option which is safe and sometimes effective is acupuncture. In most cases, medications along with treating the underlying cause, when possible, will be successful.
For intractable hiccups that have not responded to any other treatments, two procedures can be successful. A nerve blocking anesthetic can be injected into the phrenic nerve or a battery-operated nerve stimulator can be implanted near the vagus nerve.
You can reduce your risk of hiccups by treating heartburn and avoiding foods that cause heartburn, avoiding carbonated drinks, eating more frequent smaller meals than big meals (especially at night), not smoking, and drinking alcohol only in moderation.
If you have hiccups that are not going away, try supra-supramaximal inspiration. Exhale as hard as you can, inhale and hold it for 10 seconds, breathe in again and hold it for five seconds and inhale one more time and hold for five seconds. See a health-care provider for hiccups that last more than two days or keep coming back.
There are lots of ways people try to get rid of acute hiccups. Your mother may have told you to swallow sugar or hold your breath. Many of these home hiccup remedies work because they interrupt the reflex arc, although acute hiccups will stop on their own. Home remedies with some support include:
One maneuver that doctors recommend is called supra-supramaximal inspiration. Exhale as hard as you can, then take a deep breath, and hold it for 10 seconds. Inhale again and hold it for five seconds. Inhale one more time and hold for five-seconds.