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Hiccups

Woman with hiccups

What are hiccups?

Hiccups are sudden, involuntary contractions of the diaphragm that typically only last for a short period.

What causes hiccups?

Your diaphragm is a thin band of skeletal muscle that separates your chest from your abdomen and is involved in breathing. Every time you inhale, your diaphragm contracts and flattens, which creates a vacuum, drawing air into your lungs.

When you have the hiccups, your diaphragm contracts repeatedly, out of control. Each time a contraction occurs, you also experience a sudden closure of your vocal cords. This causes the characteristic “Hic” sound.

Conditions or factors that can cause a bout of hiccups include:

  • Anxiety or stress
  • Chewing gum or sucking on candy
  • Damage to the vagus or phrenic nerve
  • Damage to the central nervous system, such as that caused by multiple sclerosis, a stroke, or a traumatic brain injury
  • Drinking carbonated beverages
  • Eating too fast and swallowing air
  • Eating or drinking too much
  • Fumes
  • Infection in the central nervous system (eg, meningitis, encephalitis)
  • Smoking
  • Sudden excitement
  • Sudden temperature changes
  • Surgery
  • Tumors of the brain.

In babies, hiccups may be associated with crying, coughing, or gastroesophageal reflux.

Long term hiccups are usually caused by conditions that irritate the vagus or phrenic nerves, drugs, or by conditions that upset the balance of electrolytes in the body such as:

  • A hair in your ear touching your eardrum
  • A goiter
  • A tumor or cyst in the neck
  • Alcoholism
  • Anesthesia
  • Barbiturates
  • Corticosteroids
  • Electrolyte imbalances
  • Kidney disease
  • Sedatives
  • A sore throat or laryngitis.

What are the symptoms of hiccups?

Symptoms of hiccups include:

  • A pronounced, regular “Hic” sound
  • A rhythmic contraction of the abdomen and chest
  • A slight tightening in the chest, abdomen, or throat
  • Sometimes reflux of food.

Hiccups may be persistent enough to interfere with eating, sleep, and speech.

How are hiccups diagnosed?

Most cases of hiccups are not serious, and they get better by themselves, within a short period.

See a doctor if your hiccups are persistent and last more than three hours. Also see a doctor if they cause shortness of breath, severe abdominal pain, if you feel like your throat is going to close, or if you spit up blood. Your doctor will take a history and perform some tests if required.

How are hiccups treated?

There are various home remedies for hiccups, such as:

  • Biting on a lemon
  • Distracting yourself, such as trying to name ten types of cereal
  • Drinking a glass of water quickly or upside down
  • Having somebody frighten or surprise you
  • Holding your breath
  • Hugging your knees as close to your chest as you can
  • Placing half a teaspoon of dry sugar on the back of the tongue or swallowing a teaspoon of honey
  • Pulling hard on the tongue
  • Sipping ice-cold water
  • Sipping a small amount of vinegar
  • Sniffing smelling salts.

Treatments for persistent hiccups include:

  • Medications, such as baclofen, gabapentin, chlorpromazine, haloperidol, or metoclopramide
  • Anesthesia to block the phrenic nerve
  • Acupuncture
  • Hypnosis
  • Surgical implantation of an electronic stimulator
  • Surgery (very rarely).