Hiccups (Hiccoughs)

What are hiccups?

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).
• Alcohol.
• Excess smoking.

Treatment for short bouts of hiccups

Most cases need no treatment as a bout of hiccups usually soon goes. Popular remedies that may stop a short bout of hiccups include:

• Sipping ice 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.

Persistent hiccups lasting more than 48 hours

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, distention (stretching) of the stomach, infection of the gallbladder or infection under the diaphragm.
• A general anaesthetic.
• Conditions affecting the neck, chest or abdomen (tummy). 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 sometimes occur in the late stages of a terminal illness, such as when a person is very ill with advanced cancer.

If you have persistent hiccups

If you have hiccups for more than 48 hours (or if you have frequently recurring short bouts of hiccups) then see a doctor to find out if there is an underlying cause. If the cause is not obvious, the doctor is likely to examine you and do some tests. 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'). Treating the reflux seemed to help stop hiccups in many cases.

Which tests may be needed for persistent hiccups?

The initial tests are usually blood tests, an ECG (heart tracing) 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 persistent hiccups?

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 or 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 distended (stretched) 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 a medicine which helps to relax muscles.
• Gabapentin - this can help to relax the nerve supply to the diaphragm.
• 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 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 phrenic nerve (the nerve to the diaphragm) or to stimulate the vagus nerve (another important nerve in the neck).

For hiccups that continue despite treatment, a 'phrenic nerve block' is occasionally used. This involves interrupting the nerve supply to the diaphragm (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 abdomen, persistent hiccups may delay healing of the wound (the scar), because hiccups move the abdominal muscles. This increases the risk of complications with the wound.