How to Get Rid of the Hiccups

Hiccough or Singultus

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Hiccups, which are also referred to as hiccoughs or the medical term singultus, occur as a nervous system reflex of your phrenic, vagus, and sympathetic (associated with your fight or flight response) nerves. Any irritation along the reflex pathway will cause your diaphragm to suddenly contract and spasm. Typically only your left diaphragm will contract, however both left and right diaphragms can contract during a hiccup.

Your diaphragm is a muscle that separates your chest from your belly and assists with breathing during inhalation. When your diaphragm suddenly contracts, you breathe in air at almost the same time that your vocal cords slam shut. This influx of air against closed vocal cords results in the typical "hic" sound that is associated with the hiccups. The frequency tends to vary from person-to-person and tends to be experienced at a consistent pace between 4 to 60 hiccups per minute.

Hiccups are generally described in three categories based upon the length of time hiccups continue (not by severity):

  • Acute or transient if they last less than 48 hours
  • ​Persistent or chronic if they last more than 48 hours
  • Intractable if they they last more than 1 or 2 months

Acute hiccups are the most common and most people, if not everyone, will experience these non-threatening hiccups. While typically an annoyance or occasionally embarrassing, these will typically go away quickly within minutes or over the course of a few hours.

However, if you are experiencing persistent or intractable hiccups, you should seek medical attention as it can be a sign of an underlying disorder or cause any of the following side-effects:

  • Anxiety
  • Malnutrition and weight loss
  • Fatigue
  • Dehydration
  • Insomnia and stress
  • Decreased quality of life

Good news for women—while estrogen may cause you grief in many ways, it appears that estrogen actually helps protect you from developing persistent or intractable hiccups.

For every one woman that faces the issue, 80 men develop hiccups that last longer than 48 hours.

Common Causes for the Hiccups

In most cases, your health condition will not be the cause of your hiccups. While the causation of hiccups is not fully understood, they appear to be a response to a distended stomach. Common reasons for having a distended stomach include:

Alternately, sudden emotional changes like excitement or stress can also cause your hiccups. If you eat or drink items that suddenly alter the temperature of your stomach, you may also develop the hiccups.

Why Do I Sometimes Burp Before I Hiccup?

Right before your diaphragm contracts initiating a hiccup, the roof of your mouth and back of the tongue will raise. This position naturally is prone to allowing air from a distended stomach to come out as a burp. Burping does not always occur with hiccuping, however burping can be common since you already likely have a distended stomach with air.

Health Problems That May Cause the Hiccups

Hiccups that last more than 48 hours are uncommon. However, if you are experiencing persistent or intractable hiccups, you should see a physician, as hiccups can be a sign of other health conditions.

In general, hiccups can be caused by disorders that cause irritation of the vagus or phrenic nerve. Common causes of vagus or phrenic nerve irritation, related to many parts of your body, include:

Less common causes of hiccups caused by vagus or phrenic nerve irritation includes:

  • Cardiac problems — heart attack and pericarditis
  • Thoracic or gastrointestinal cancer
  • Medications

Treating Transient Hiccups

Hiccups that occur for less than 48 hours do not require any treatment. However, even if no treatment is required, you may still want to try some things to get them to stop. While there is no guaranteed cure for transient hiccups, here are some things to try (these are not ordered by efficacy, as this is not well understood):

  1. Valsalva maneuver or bearing down, like when trying to unplug your ears
  2. Taking a deep breath and holding it in
  3. Breathing into a paper bag (never use a plastic bag), like treatment for hyperventilation
  4. Eating a spoonful of sugar, dry bread, or crushed ice
  5. Pulling on your tongue
  6. Have someone scare you
  7. Drink dill seed tea
  8. Gargling or drinking cold water
  9. Drinking water while bending over—caution: do not attempt this if you have difficulty swallowing
  10. Applying light pressure to your eyes

The theory behind many of the tricks listed above are similar to treating certain rapid heart conditions by stimulating your vagus nerve. In supraventricular tachycardia, a type of rapid heart rate, stimulating the vagus nerve slows the heart rate down so the doctor can assess your heart rhythm. Similarly, stimulating the vagus nerve when you have the hiccups counteracts the irritation that caused your hiccups.

If the above tricks do not work, it does not mean you have a medical condition causing your hiccups. You may find that one works well for you and does not work for someone else. Likewise, you may find that some of the tricks work for you sometimes while other tricks will work for you at other times.

Treating Persistent or Intractable Hiccups

If your hiccups are caused by medical conditions, the tricks listed above will likely provide little to no benefit. If your physician is able to identify the cause of your hiccups, your treatment will be directed toward the cause. For example, if you have GERD that is causing you to have the hiccups, treating GERD with proton pump inhibitors, like Dexilant or Prilosec, will treat your acid reflux and help prevent hiccups from occurring.

If your hiccups are related to chemotherapy treatments or other therapies that cannot be stopped, your doctor may try some medications to help control the frequency and duration of your hiccups. Muscle relaxants, medications for nerve pain, and antipsychotic medications may be trialled to determine if there is any reduction in your hiccups. Acupuncture may also be tried, however there is limited evidence of any efficacy.

If your hiccups are severe enough to be causing malnutrition or significant reduction in quality of life, more invasive methods may be tried. Invasive procedures should only be performed after all non-invasive methods have been tried and only as a last resort. These include the following:

  • Phrenic nerve block
  • Vagus nerve stimulation
  • Diaphragm pacemaker

A Word From Verywell

Most cases of the hiccups are transient and an annoyance more than a medical problem. Very few interventions will work all of the time but several of them may prove to benefit you when you have cases of the hiccups. Preventing an over-distended stomach by not overeating, eating or drinking too quickly, reducing carbonated beverages, or drinking too much alcohol is the best way to avoid developing the hiccups.

Sources:

Bope, ET & Kellerman, RD. (2017). Symptomatic Care Pending Diagnosis. Conn's Current Therapy. Elsevier. 1, 1-65.

First Consult: Hiccups. Clinical Key website. http://www.clinicalkey.com (Subscription Required). Published March 14, 2013.

Hiccups. Merck Manual website. http://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gi-disorders/hiccups​. Updated March 2016.

Overview of Hiccups. Uptodate website. http://www.uptodate.com (Subscription Required). Updated May 2, 2016.

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