Reasons You Might Have Hiccups and How to Treat Them

Meet Charles Osborn. On June 13, 1922, Osborn lifted a pig onto a scale moments before the pig became bacon. Osborn began to hiccup and continued to do so for the next 68 years. His hiccups ended on June 5, 1990, and Osborn passed away in May of 1991.

Osborn holds the Guinness World Record for hiccups.

Let’s look at what hiccups are, the reasons you get them, treatment for occasional and intractable hiccups, and how to find the lowest prescription prices at a pharmacy near you so you can avoid being in the record book.

What is a hiccup?

A hiccup is an involuntary contraction of the diaphragm, the breathing muscle located between your lungs and abdomen. Rapid closure of the vocal cords following the involuntary contraction or spasm of the diaphragm is what causes you to make the “hic” sound.

Who gets hiccups and why?

Everyone experiences hiccups, even unborn babies. Newborns spend an average of 15 minutes a day hiccupping. Infants born prematurely may spend even more time hiccupping. Some researchers believe hiccups exercise the diaphragm before birth in preparation for breathing. Hiccups continue more frequently in the newborn period to get the nerve connection between the brain and diaphragm strengthened.

For adults, a short-term case of the hiccups seems to be a leftover or vestigial response—a throwback to fetal days. Males of all ages have hiccups more than females, particularly older men. This statement is meant to convey a fact, not a judgment!

Your ethnicity and where you live do not seem to affect your chance of having hiccups.

What are persistent and intractable hiccups?

Thankfully, most hiccups disappear on their own within an hour or two. These are called acute or short-term hiccups. If you have hiccups lasting more than two days but less than a month, you have persistent hiccups. And if your hiccups last a month or longer, you have intractable hiccups.

Persistent and intractable hiccups disrupt sleep and interfere with normal eating. People with both persistent and intractable hiccups typically suffer from exhaustion and weight loss. They also can have trouble speaking and avoid social activities. Quality of life diminishes with long-lasting hiccups.

Fortunately, having a prolonged course of hiccups is very rare. When they do occur, they happen more often to:

• Older men
• People of greater height and weight
• People with acid reflux (GERD)
• People with nervous system disorders such as Parkinson’s Disease

Reasons you might get short-term or acute hiccups

From time to time, everyone experiences hiccups that are acute and go away on their own. What triggers hiccups, though, can vary widely. Here are some causes of short-term hiccups:

• Stomach distention from eating too much
• Eating spicy food
• Acid reflux (GERD)
• Drinking alcohol
• Drinking carbonated beverages
• Drinking very hot or very cold drinks
• Swallowing air when you chew gum
• Exposure to a drastic, sudden change in temperature
• Experiencing emotional stress, anxiety, or excitement

Home remedies for short-term hiccups

Most people do not seek medical care for short-term hiccups, preferring to try home remedies instead. Researchers have shown raising the level of carbon dioxide in your body, which you release as you exhale, can put a stop to hiccups. You can try these maneuvers:

• Breathe into a paper bag
• Briefly hold your breath
• Relax and inhale to a count of five and exhale to a count of five

Researchers have also found getting the vagus nerve to fire may stop hiccups. The vagus nerve runs from the brain, helps regulate your vocal cords and diaphragm, and ends in your pelvis. These remedies stimulate the vagus nerve. Like the remedies above, they have mixed results:

• Make yourself gag
• Pull on your tongue
• Drink or gargle with ice water
• Do a Valsalva maneuver by exhaling while pinching your nose and keeping your mouth closed
• Have an orgasm

Other folkloric home remedies that have tradition rather than science backing them include:

• Wet a red piece of string in your mouth and then put it on your forehead (Latin America)
• Picture a green cow grazing in a blue field (Ireland)
• Put a knife in a water glass and drink from it while you hold your breath (Norway)
• Figure out who’s gossiping about you (Hungary)

Causes of persistent and intractable hiccups

A serious medical condition may be causing your persistent and intractable hiccups. With persistent and intractable hiccups, you should make an appointment with your healthcare provider. Based on your medical history and physical exam, your healthcare provider may order blood tests and imaging studies such as an x-ray, CT scan, or MRI.

A medical condition may be the underlying cause of long-term hiccups. Hiccups can result from disorders that affect the brain, nerves and sensory organs, heart, lungs, and gastrointestinal tract. Diseases or tumors that press on or irritate nerves that trigger hiccups may be the cause. Metabolic diseases that alter the sodium, potassium, and calcium in your blood may trigger hiccups.

From your head down, here is a partial list of reasons you may have persistent or intractable hiccups:

• Strokes
• Abnormal blood vessels in your brain
• Head injury or skull fracture
• Brain tumors
• Brain infections—meningitis, brain abscess
• Parkinson’s disease
• Multiple sclerosis
• Impacted ear wax or even a hair tickling your eardrum
• Laryngitis or throat infection
• Tumors, cysts, or thyroid goiters that press on nerves in your neck, including esophageal cancer
• Pneumonia
• Heart attack or inflammation of the covering of the heart (pericarditis)
• Gastroesophageal reflux (GERD)—is the cause of long-term hiccups in up to 80% of people
• Inflammation of the stomach lining or pancreas
• General anesthesia and abdominal surgery
• Diabetes
• Kidney failure
• Chronic alcohol misuse

Medications may also cause long-term hiccups. They include:

• Dexamethasone—a steroid
• Chemotherapy drugs—carboplatin, cisplatin, etoposide, fluorouracil, irinotecan, levofolinate, oxaliplatin
• Morphine
• Benzodiazepines (Valium, Midazolam)
• Tramadol
• Azithromycin (Z-Pak)
• Alpha-methyldopa for high blood pressure
• Levodopa—treats symptoms of Parkinson’s disease

Treating persistent and intractable hiccups

With persistent and intractable hiccups, treatment is based on correcting any underlying medical condition. Treatment may be as simple as removing impacted ear wax or taking you off a medication that’s causing hiccups. Or treatment may involve prescribing antibiotics for an infection or removing a tumor.

Current medical literature breaks down treatment for hiccups lasting longer than 48 hours (persistent and intractable) this way:

• Look for treatable causes for hiccups, such as cleaning out earwax or discontinuing medications that trigger hiccups and replacing them with medications that don’t cause hiccups
• Try physical maneuvers as listed above.

Medications for persistent and intractable hiccups

If physical maneuvers don’t work, your healthcare provider will begin trying medications to relieve hiccupping.

First-line therapy

Since GERD is a typical culprit, your healthcare provider will likely treat you with proton pump inhibitors:

• Omeprazole (Prilosec)
• Lansoprazole (Prevacid)
• Pantoprazole (Protonix)
• Esomeprazole (Nexium)
• Rabeprazole (Aciphex)
• Dexlansoprazole (Dexilant)

PPI medication trials last for three to four weeks if you have signs and symptoms of acid reflux.

Even if you don’t have reflux symptoms, PPIs are still considered first-line therapy for hiccups since GERD may be present without symptoms.

Second-line therapy

If your hiccups continue despite treatment for GERD, your healthcare provider may discontinue the PPIs and start a second-line therapy. A trial of one of these medications typically lasts 10 to 15 days:

• Gabapentin (Neurontin)
• Baclofen—slower to take effect than gabapentin

If one of these medications stops your hiccups, you and your healthcare provider will gradually reduce the dose until you are off the medication.

If the hiccups return, you’ll restart the medication and reduce the dose to the lowest amount that’s effective at preventing hiccups.

In the event gabapentin or baclofen don’t help you with your hiccups, the next medication to try is metoclopramide (Reglan). This medication is trialed for 10 to 15 days.

If hiccups persist, it’s time to try chlorpromazine (Thorazine), the only Food and Drug Administration (FDA)-approved medication for long-term hiccups. Chlorpromazine is not used as often as first-line therapy because it has significant side effects including:

• Dizziness
• Anxiety or agitation
• Shuffled walking
• Slow or unusual body movements
• Uncontrolled facial movements
• Increased appetite and weight gain
• Fevers
• Seizures
• Vision problems

It may take several different drug trials to find something that helps with your hiccups. The approach above is a guide. Your healthcare provider will start with medications based on your underlying health issues, potential interactions with other medications you take, and your tolerance for side effects, not necessarily in the order listed above.

Ways to save money as you trial medications

Treating persistent and intractable hiccups means visits to your healthcare provider or emergency room. Add in several tests and trials of medications, and you’re spending money every time you turn around.

At ScriptSave^® WellRx, we can help you find the lowest prescription prices at a pharmacy near you. It’s as easy as typing in the medication and your zip code to compare prices for the very same prescription in your neighborhood.

The excitement you get from saving money on prescriptions may be enough to stop your hiccups!

To learn more about how prescription drug cards work and to receive your free Rx card and coupons for medications, visit WellRx or watch our video here.

Treatment targeting nerves

If there is no clear or treatable underlying disease and medications aren’t effective, treatment targeting the nerves involved in hiccups may be the next step. Those nerves are the vagus and phrenic.

A vagus nerve stimulator is an implanted device that sends an electrical impulse to the vagus nerve. It is approved to treat seizures and depression but is not FDA-approved for the treatment of intractable hiccups. There are several reports of its use that show mixed results.

The phrenic nerve causes the diaphragm to contract and relax. Since involuntary contractions of the diaphragm cause hiccups, temporarily numbing the phrenic nerve on one side of the diaphragm may cure hiccups. Numbing the phrenic nerve is an option after other treatments have failed. If temporarily numbing the phrenic nerve works, permanent numbing, again on only one side of the diaphragm, is an option to consider.

Alternative treatments

Alternative treatments have varying success rates and include massage, hypnosis, and acupuncture. Acupuncture is beneficial if your intractable hiccups are due to a stroke or cancer.

Alternative treatments have low complication rates and are worth trying for elderly people or those who are not healthy enough to tolerate medications or surgical procedures.

Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

Resources:

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11. https://www.mayoclinic.org/diseases-conditions/hiccups/symptoms-causes/syc-20352613#:~:text=A%20cause%20of%20long%2Dterm,which%20serve%20the%20diaphragm%20muscle.
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14. https://jhoponline.com/jhop-issue-archive/2014-issues/december-vol-4-no-4/16296-hiccups
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