Hiccups

What are hiccups?

Hiccups are repeated spasms of your diaphragm paired with a “hic” sound from your vocal cords closing. Your diaphragm is a thin, dome-shaped muscle that separates your chest from your belly. It moves downward when you breathe in and upward when you breathe out.

Two things happen when you hiccup:

• Your diaphragm pulls down suddenly between breaths, making you quickly suck in air.
• The glottis (space between your vocal cords) suddenly closes to stop more air from coming in.

These actions make the “hic” sound of a hiccup.

Hiccups usually go away on their own without any treatment. However, some people have hiccups that go on much longer than normal. You should call a healthcare provider if your hiccups last longer than two days. This could be a sign of a more serious condition that needs medical attention.

Other names for hiccups include:

• Hiccough.
• Singultus.

Types of hiccups

Healthcare providers classify hiccups according to how long they last:

• Transient (temporary) hiccups last a few seconds or minutes.
• Persistent hiccups last longer than 48 hours for up to one month.
• Intractable hiccups last longer than one month.
• Recurrent hiccups keep coming back, with each episode lasting longer than just a few minutes.

What are the symptoms?

The main symptoms of hiccups are a spasm in your diaphragm and a “hic” sound that comes out of your mouth. Some people with persistent hiccups experience spasms in their diaphragm without the “hic” sound.

What causes hiccups?

Hiccups happen when something irritates the nerves that cause your diaphragm to contract. These nerves, including your vagus nerve and phrenic nerve, make up a pathway that experts call a reflex arc. Reflex arcs manage your body’s involuntary functions. These are processes you don’t consciously control (like breathing, digestion and heart rate). Irritation of the nerves that control your diaphragm can cause it to suddenly contract.

So, why do hiccups happen for just a short time in most people but for much longer in others? That’s because the causes of transient hiccups (lasting a few seconds to a few minutes) are different from the causes of persistent or other long-lasting hiccups.

Causes of transient hiccups

There’s often no clear cause for a random hiccup or two. But certain triggers might play a role, like:

• Eating too much or too fast.
• Eating spicy foods or foods that are very hot or cold.
• Drinking carbonated beverages.
• Swallowing excessive air (aerophagia).
• Smoking tobacco or cannabis.
• Drinking beverages containing alcohol.

Causes of persistent and intractable hiccups

Various medical conditions can cause persistent hiccups, including:

• Gastrointestinal diseases, like GERD or gastritis.
• Conditions affecting your central nervous system, like stroke, Parkinson’s disease or multiple sclerosis.
• Lung conditions, like pneumonia, pulmonary embolism or pleurisy.
• Tumors or lesions, like mediastinal tumors, esophageal cancer or pancreatic cancer.
• Conditions that disrupt your metabolism and related nerve signaling, like uremia or hypocalcemia.
• Certain infections, like flu, shingles and herpes simplex.

Some medications can also cause persistent hiccups. Examples include:

• Dopamine agonists.
• Benzodiazepines (at low doses).
• Some chemotherapy drugs.
• Dexamethasone.
• Azithromycin.

Persistent hiccups may also happen after certain surgeries or procedures, including those that require general anesthesia.

What are the complications of hiccups?

Transient hiccups don’t lead to complications. But persistent hiccups may lead to:

• Trouble breathing, swallowing or speaking.
• Difficulty sleeping and exhaustion.
• Weight loss.

What causes newborn hiccups?

Hiccups are common and normal in babies. Healthcare providers don’t know exactly why baby hiccups happen, but they believe it’s because of increased gas in your baby’s stomach. Your baby might eat a lot or swallow too much air while eating. As a result, their tummy expands and irritates their diaphragm.

In some babies, hiccups are a sign of GERD. In this case, your baby will have other symptoms besides hiccups, like coughing and spitting up. Call your pediatrician if you notice these issues.

How are hiccups diagnosed?

If you have hiccups for just a few minutes, you likely won’t think to call a healthcare provider. But you should call one if your hiccups last more than two days (persistent hiccups). They may ask you to come in for an appointment where they’ll:

• Learn your medical history, including any recent surgeries.
• Ask about medications you’re taking.
• Ask about any other symptoms you’re having.
• Do a physical exam.

Your provider will use this information to identify what’s causing your persistent hiccups. Hiccups that won’t go away are sometimes a sign of a more serious condition that needs diagnosis and treatment.

Tests

Your provider may order some tests to find the cause of your persistent hiccups. Tests you may need include:

• Blood tests.
• Chest X-ray.
• Electrocardiogram (EKG).
• Upper endoscopy.
• Abdominal CT scan.
• Brain MRI.

How can I get rid of hiccups?

The verdict is still out on how to stop hiccups that happen randomly. Experts haven’t found a hiccup cure. But transient hiccups usually go away on their own without you doing anything to stop them.

Still, you may feel so annoyed that you want to try a home remedy. Anecdotal evidence suggests certain home remedies might help by stimulating your vagus nerve or increasing carbon dioxide levels in your lungs.

To try and get rid of bothersome transient hiccups, you can:

• Briefly hold your breath.
• Sip cold water.
• Press on your eyes.
• Pull on your tongue.
• Bite into a lemon.
• Breathe into a paper bag (not plastic).
• Swallow a spoonful of sugar.
• Drink or gargle ice water.

Treatment for persistent or intractable hiccups

Hiccups that last longer than two days are more than just a nuisance. They can interfere with your quality of life and lead to trouble with basic needs like eating or sleeping. Possible medications a healthcare provider may prescribe for you include:

• Chlorpromazine.
• Proton pump inhibitor (medicines that reduce stomach acid).
• Metoclopramide.
• Baclofen.
• Gabapentin.

Your provider will determine the best medicine according to the cause of your hiccups.

If another medication you’re taking is causing your hiccups, your provider may tell you to stop taking it and take another instead. Never stop taking a medication unless your provider tells you to.

Other treatments your provider may suggest include nerve blocks or hypnosis. There’s currently limited data to support the use of acupuncture in treating hiccups.

Can I prevent hiccups?

You may be able to prevent transient hiccups by:

• Slowing down your pace when you eat or drink.
• Limiting carbonated beverages and beverages containing alcohol.
• Eating smaller portions at a time.
• Avoiding foods that are very hot or cold.

How long will I have hiccups?

Transient hiccups go away within a couple minutes. Persistent or intractable hiccups can last days, weeks or even months.

Can hiccups go away on their own?

Yes. Transient hiccups usually go away without any home remedies or other treatment. However, persistent or intractable hiccups often need treatment.

Why do I keep getting hiccups?

There are many reasons why you might keep getting hiccups. If you seem to get them often, think about what you’re doing immediately before the hiccups start. It may help to keep a journal. You may then notice patterns (like hiccups that often happen after eating or drinking certain things). Talk to your healthcare provider if you have concerns or if your hiccups go on for more than two days straight.

When should I see my healthcare provider?

Call your healthcare provider if your hiccups last longer than two days.

When should I go to the emergency room?

Call 911 or your local emergency number if you have hiccups along with symptoms of a stroke or pulmonary embolism. These are medical emergencies, and you need immediate care.