Hiccups: What Are They, and How Can We Stop Them?

Hiccups are that strange occurrence that comes out of nowhere, causes irritation, and then (usually) disappears.

Everyone has hiccups at some point, sometimes even at inconvenient times. What is going on in that body that causes hiccups, and what are ways to get rid of them? Let’s look at the biology of hiccups, the causes, and how to treat this generally harmless but annoying condition.

Hiccups are brief, involuntary, and irregular bursts of air that are really 2 different events causing 1 hiccup. First, there is an involuntary contraction of the diaphragm, the muscle at the base of the lungs. The second event is the closing of the glottis. It is here that the vocal cords are located, causing the "hic" sound.^1,2 Most hiccups cease within hours and are harmless and self-limiting. They can last in cycles of 4 to 60 hiccups per minute and are classified by their duration into 3 categories³: acute: <48 hours; persistent: >2 days; and intractable: >1 month.

The results of a retrospective analysis of 54 charts at a community hospital between 1995 and 2000 shows that intractable hiccups are more common in men (82%) than in women, and 36 of those men were between 51 and 80 years of age.⁴ The results of a 2012 systemic review found that 1% to 9% of patients with advanced cancer experienced intractable or persistent hiccups.⁵ Because hiccups are a common occurrence with no geographical or racial variation, little is documented or known about the incidence and prevalence.² The effects of hiccups can include inconveniences in communicating, drinking, eating, and sleeping.

Below are a few examples of risk factors that cause hiccups^1,3,6. Additionally, a thorough assessment and physical examination can help determine the cause.

• Central nervous system (CNS) disorders: brain injuries or seizures
• Diet: alcohol consumption, eating too quickly, and overeating
• Gastrointestinal disorders: esophagitis and gastroesophageal reflux disease
• Medication induced: benzodiazepines and dexamethasone
• Psychosomatic: anxiety and fear
• Miscellaneous: cancer, imbalances, and surgery

We have all heard of or even tried home remedies, some reportedly successful. Some fun examples you might have heard of include eating a spoonful of sugar, receiving a sudden or fright, or singing a song.^7,8 Some physical maneuvers that reportedly get rid of hiccups include drinking water, holding one’s breath, and pulling the knees to the chest.⁹

Pharmacotherapy may be considered for intractable and persistent hiccups. The drug choice will be based on the underlying cause, and because this can vary among patient, the medication chosen will also vary. A 2015 systematic review for the pharmacological treatment of hiccups and a 2016 review of the management of hiccups in palliative care patients list the following medication recommendations:^9,10

• Baclofen 5 to 15 mg 3 times daily: Considered first line for suspected CNS cause
• Metoclopramide 10 mg 3 times daily: Considered first line for non-CNS cause
• Proton pump inhibitors, omeprazole 20 mg twice daily: Considered first line when suspecting reflux
• Gabapentin 100 to 300 mg 3 times daily: Considered second line
• Chlorpromazine* 10 to 50mg 3 times daily by mouth or intravenously: Considered third line, because of adverse effects

*Only drug FDA approved to treat hiccups

Conclusion

Hiccups are generally harmless but can cause distress and inconvenience. Obtaining knowledge on the science behind and causes of hiccups provide insight on how to treat this peculiar occurrence.

References

1. Hiccups. MedlinePlus. Updated February 17, 2021. Accessed March 24, 2021. https://medlineplus.gov/hiccups.html

2. Lembo A. Hiccups. In: UpToDate. Wolters Kluwer; 2021. Updated October 27, 2020. Accessed March 24, 2021. https://www-uptodate-com.mwu.idm.oclc.org/contents/hiccups?search=hiccups&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

3. Nausheen F, Mohsin H, Lakhan SE. Neurotransmitters in hiccups. Springerplus. 2016;5(1):1357. doi:10.1186/s40064-016-3034-3

4. Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc. 2002;94(6):480-483.

5. Calsina-Berna A, Garcia-Gomez G, Gonzalez-Barboteo J, Porta-Sales J. Treatment of Chronic Hiccups in Cancer Patients: A Systematic Review. J Palliat Medi. 2012;15(10):1142-1150. doi:10.1089/jpm.2012.0087

6. Cole JA, Plewa MC. Singultus. In: StatPearls. StatPearls Publishing; 2021.

7. Cabrera D. Hiccups: old remedies for an old malady. EMBlog Mayo Clinic. October 27, 2014. Accessed March 26, 2021. https://emblog.mayo.edu/2014/10/27/hiccups-old-remedies-for-an-old-malady/

8. Vatomsky S. 7 cures for hiccups from world folklore. Mental Floss. May 15, 2017. Accessed March 26, 2021. https://www.mentalfloss.com/article/500937/7-cures-hiccups-world-folklore

9. Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care. 2018;8(1):1-6. doi:10.1136/bmjspcare-2016-001264

10. Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015;42(9):1037-1050. doi:10.1111/apt.13374