Overview
Hiccups are involuntary spasms of the diaphragm, immediately followed by sudden closure of the vocal cords, producing the characteristic sound. Most bouts last only a few minutes. Persistent hiccups (over 48 hours) or intractable hiccups (over 1 month) are uncommon but can signal an underlying medical condition.
How common is it?
Virtually everyone experiences brief hiccup episodes. Persistent hiccups lasting over 48 hours affect a small minority and are more common in men. Intractable hiccups can last for years and have a significant impact on quality of life.
Causes and risk factors
Brief hiccups are usually triggered by gastric distension or irritation. Persistent hiccups often have a central nervous system or metabolic cause.
Common risk factors
- Eating too quickly or too much (gastric distension)
- Swallowing air, hot or spicy food, or carbonated drinks
- Alcohol
- Sudden temperature change in the stomach
- Gastroesophageal reflux
- Excitement or emotional stress
- Persistent: central nervous system lesions (brainstem, vagus nerve), metabolic disorders (uraemia, hyponatraemia), medications (steroids, chemotherapy), tumours
Symptoms
- Repeated involuntary contractions of the diaphragm producing the characteristic hic sound
- Chest or abdominal discomfort with prolonged bouts
- Difficulty eating or sleeping with persistent hiccups
- Fatigue and weight loss if hiccups are intractable
When to see a doctor
Hiccups lasting more than 48 hours always require medical assessment to identify an underlying cause. Hiccups with other neurological symptoms (headache, difficulty swallowing, weakness) need urgent review.
Diagnosis
Brief hiccups need no investigation. For persistent hiccups: full blood count and metabolic panel, chest X-ray, CT brain and chest, upper GI endoscopy.
Treatments
Home remedies for brief hiccups
Breathing into a paper bag, holding the breath, drinking cold water quickly, or pressure on the back of the throat stimulates the vagus nerve and often terminates a brief bout.
Pharmacological treatment for persistent hiccups
Metoclopramide, omeprazole (if reflux-related), chlorpromazine (the only FDA-approved drug for hiccups), or baclofen for central causes. Gabapentin is used for intractable cases.
Phrenic nerve block or surgery
Reserved for truly intractable cases unresponsive to all medication. Phrenic nerve block temporarily or permanently interrupts the reflex arc.
Self-care and lifestyle
- Eat slowly and chew food thoroughly
- Avoid carbonated drinks and excess alcohol
- Reduce portion sizes if reflux is a trigger
- Avoid eating very hot or very cold foods rapidly
Prevention
Eating and drinking slowly, avoiding triggers, and treating gastroesophageal reflux reduce the frequency of hiccup episodes.