A hiccup is an automatic action (a reflex) that the body can't control. During a hiccup your diaphragm (the muscle under your lungs that helps you breathe) contracts. Immediately after this the top of your windpipe (your glottis) closes, making the typical 'hic' sound.
What are the symptoms?
Seriously, you want me to describe a hiccup? I think you know what it is. What you may not know is that there is a big difference between a bout of hiccups that lasts for a short time and one that lasts for more than 48 hours. The persistent type is more likely to be caused by an underlying illness and may be more likely to require medication to treat it.
Read more about the symptoms of hiccups.
What causes them?
We've all seen the comedy drunk on TV (or in the mirror) hiccuping and slurring their words. But alcohol is not the only cause of a short bout of hiccups. Sudden excitement, excessive smoking and sudden changes in temperature will do it. So will trying to drink a whole bottle of cola in one go. But what idiot would try that? Certainly not me (hic).
In most cases, no particular cause can be found.
More persistent bouts (lasting longer than 48 hours) don't happen very often. Acid reflux, changes in body chemistry, and conditions affecting the neck, chest, tummy, heart and brain can all cause them. Some medicines and anaesthetics are known causes. Prolonged hiccups can also be a distressing feature of advanced cancer.
Learn more about the causes of hiccups.
What tests do I need?
Chances are you won't need any tests unless your hiccups are frequent or prolonged. If they are, you'll most likely end up with blood tests, a heart tracing and a chest X-ray. If your doctor thinks you have an unusual cause, they may request other tests.
Find out more about the diagnosis of hiccups.
What are the treatment options?
Short bouts of hiccups
Hiccups usually stop without any treatment but someone will suggest putting your fingers in your ears, blocking your nostrils and taking a sip of water from a glass. It may not stop the hiccups but it will provide some wonderful Instagram® moments. Other tricks involving iced water, sugar and lemons have been suggested. If they don't work, you still have the basics for a lovely lemon drizzle cake.
Fortunately, there's a little more scientific evidence backing up the treatments for prolonged bouts of hiccups. Treating any underlying cause is an obvious step. Medicines which relax the diaphragm muscle, such as chlorpromazine or baclofen, may be worth a try. Other approaches include medicines which combat acid reflux, relax the stomach muscles or calm the nerve supply to the diaphragm.
Treatments which do not involve taking medicines and have helped some people include acupuncture, hypnotherapy and a device similar to a pacemaker which has an effect on the phrenic nerve that controls the diaphragm muscle. As a last resort, an injection which blocks the action of the phrenic nerve can be used but this can have an effect on breathing.
Read more about the treatment of hiccups.
Are there any complications?
Short bouts of hiccups don't usually cause complications (unless you're a professional fire-eater).
Longer bouts can be quite exhausting, particularly if they interrupt sleep. If you've just had a tummy operation they can also slow up the healing of the scar.
Find out more about the complications of hiccups.
What are the symptoms of hiccups?
Everyone has had hiccups, and knows exactly what they are and what they feel like. They affect women and men equally, although persistent hiccups occur much more commonly in men. They happen mainly in the evening.
There is an important difference between short bouts of hiccups and persistent hiccups (lasting longer than 48 hours). Persistent hiccups are more likely to be linked to an underlying illness and you may need medical tests.
What causes short bouts of hiccups?
Most people have bouts of hiccups from time to time. In most cases they start for no apparent reason, last a short while, then stop. Sometimes they are due to:
- Sudden excitement or emotional stress.
- A temporary swollen stomach caused by overeating or eating too fast, drinking fizzy drinks, or swallowing air.
- A sudden change in temperature (very hot or cold food or drinks, a cold shower, etc).
- Excess smoking.
What causes persistent hiccups?
Persistent hiccups are rare.
- In some cases, persistent hiccups are caused by an underlying disease. Over 100 diseases have been reported to cause hiccups. Some are common, such as acid reflux, and some are rare. You would normally have other symptoms apart from the hiccups.
- In some cases of persistent hiccups there is no apparent cause. However, the persistent hiccups can become exhausting and distressing.
Examples of conditions which can cause persistent hiccups are:
- Certain medicines - examples are steroids, tranquillisers, painkillers containing opiates (such as morphine) and methyldopa (for blood pressure).
- Changes in blood chemistry such as from alcohol, high blood sugar, or lack of calcium or potassium in the blood.
- Gut problems such as acid reflux, stretching (distension) of the stomach, infection of the gallbladder or infection under the diaphragm.
- A general anaesthetic.
- Conditions affecting the neck, chest or tummy (abdomen). For example, surgery, infections (such as sore throat or pneumonia), swellings or tumours in these parts of the body.
- Some heart conditions - a heart attack or inflammation around the heart.
- Brain conditions such as stroke, head injury or brain infection.
- Hiccups which sometimes occur in the late stages of a terminal illness such as when a person is very ill with advanced cancer.
Do I need any tests?
You are unlikely to need any tests unless you have persistent hiccups lasting more than 48 hours or frequent recurring short bouts of hiccups Unless your doctor can find an obvious cause, they will most likely want to do some tests.
The initial tests are usually blood tests, a heart tracing (electrocardiogram, or ECG) and a chest X-ray. These look for changes such as blood chemistry, chest problems or heart disease.
Other tests may be advised, depending on your individual situation and whether any other medical condition is suspected.
What is the treatment for hiccups?
Short bouts of hiccups
Most cases need no treatment, as a bout of hiccups usually soon goes.
There are many popular remedies that are said to stop a short bout of hiccups but they are based on people's individual experiences. It is not clear how effective they are, as they have not been tested by research trials. They include the following:
- First, block off all airways by putting fingers in your ears and blocking your nostrils. Then, take a sip or two of water from a glass. It is possible to do this alone (looks a bit silly - but is possible) but you may find it easier with an assistant.
- Sipping iced water.
- Swallowing granulated sugar.
- Biting on a lemon or tasting vinegar.
- Breath holding, breathing fast, or breathing into a paper bag.
- Gasping after a sudden fright, or sneezing.
- Pulling your knees up to your chest and/or leaning forward to compress the chest.
- Using a technique called the Valsalva manoeuvre. (The Valsalva manoeuvre means trying to push your breath out while you hold your throat and voice box closed.) The way to do this is to take a deep breath in, then keep the air inside you while pushing with your muscles as if to force the air out. This is like pushing in childbirth or straining on the toilet.
What is the treatment for persistent hiccups?
If an underlying cause is found then treatment of the underlying cause, if possible, may cure the hiccups. For example, one research study found that many people with persistent hiccups had a gut condition called acid reflux. See separate leaflet called Acid Reflux and Oesophagitis for more details. Treating the reflux seemed to help stop hiccups in many cases. Firstly, try any of the popular remedies used to treat short bouts of hiccups (explained above). Also, treat any underlying cause, if possible.
Secondly, medication is sometimes needed to stop persistent hiccups. Various medicines have been used for this. The following medicines may be used for treating adults with hiccups (for children, specialist advice is recommended):
- Chlorpromazine and haloperidol are medicines which can relax the diaphragm muscle or its nerve supply and may stop persistent hiccups.
- For stomach problems such as acid reflux or a stretched (distended) stomach: anti-acid medicines (various types, such as omeprazole or ranitidine) or medicines which help the stomach to empty faster (such as metoclopramide).
- Baclofen - this is a medicine which helps to relax muscles.
- Gabapentin - this can help to relax the nerve supply to the muscle under your lungs that helps you breathe in (the diaphragm).
- Ketamine - an intravenous anaesthetic - is sometimes effective when other treatments have failed.
- Giving a medication called metoclopramide by intravenous injection has been reported to cure hiccups occurring after anaesthetic.
- For people with a terminal illness, sedatives such as midazolam can help to control hiccups and relieve the stress they cause.
Referral to a specialist is often advised for persistent hiccups, either to look for a cause, or to offer more treatment options. Some examples of treatments that have been successfully used for persistent hiccups are:
- Acupuncture or hypnotherapy.
- A device similar to a pacemaker. This is used to stimulate or pace the nerve to the diaphragm (the phrenic nerve) or to stimulate another important nerve in the neck, called the vagus nerve.
For hiccups that continue despite treatment, a phrenic nerve block is occasionally used. This involves interrupting the phrenic nerve - for example, by injecting a local anaesthetic near the nerve. However, this treatment needs to be considered carefully: it carries risks because the phrenic nerve is important in breathing.
Are there any complications of hiccups?
Short bouts of hiccups do not normally cause any problems or complications.
Persistent hiccups may cause complications such as tiredness, exhaustion or poor sleep. Also, they may cause psychological distress or embarrassment. For people who have had recent surgery to the tummy (abdomen), persistent hiccups may delay healing of the scar (wound), because hiccups move the abdominal muscles. This increases the risk of complications with the wound.
Further reading & references
- Chang FY, Lu CL; Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil. 2012 Apr;18(2):123-30. doi: 10.5056/jnm.2012.18.2.123. Epub 2012 Apr 9.
- Seker MM, Aksoy S, Ozdemir NY, et al; Successful treatment of chronic hiccup with baclofen in cancer patients. Med Oncol. 2011 Mar 26.
- Asadi-Pooya AA, Petramfar P, Taghipour M; Refractory hiccups due to phenytoin therapy. Neurol India. 2011 Jan-Feb;59(1):68.
- Lin LF, Huang PT; An uncommon cause of hiccups: sarcoidosis presenting solely as hiccups. J Chin Med Assoc. 2010 Dec;73(12):647-50.
- Marinella MA; Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009 Jul-Aug;7(4):122-7, 130.
- Arsanious D, Khoury S, Martinez E, et al; Ultrasound-Guided Phrenic Nerve Block for Intractable Hiccups following Placement of Esophageal Stent for Esophageal Squamous Cell Carcinoma. Pain Physician. 2016 May;19(4):E653-6.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Laurence Knott
Prof Cathy Jackson