Hiccups

Overview

Hiccups are repeated spasms or sudden movements of the diaphragm that you can't control. The diaphragm is the muscle that separates your chest from your stomach area and plays an important role in breathing. A spasm in your diaphragm causes your vocal cords to suddenly close, producing a "hic" sound.

Eating a large meal, drinking alcoholic or carbonated beverages, or getting excited suddenly may cause hiccups. In some cases, hiccups may be a sign of an underlying medical issue. For most people, hiccups usually last only a few minutes. Rarely, hiccups may continue for months. When they last that long, they can result in weight loss and extreme tiredness.

Symptoms

Symptoms include uncontrolled spasms in your diaphragm and a "hic" sound. Sometimes you may feel a slight tightening sensation in your chest, stomach area or throat.

When to see a doctor

Make an appointment to see your health care provider if your hiccups last more than 48 hours or if they're so severe that they cause issues with eating, sleeping or breathing.

Causes

The most common triggers for hiccups that last less than 48 hours include:

• Drinking carbonated beverages.
• Drinking too much alcohol.
• Eating too much.
• Being excited or under emotional stress.
• Experiencing sudden temperature changes.
• Swallowing air, such as when chewing gum or smoking.

Issues that may cause hiccups to last more than 48 hours include nerve damage or irritation, central nervous system disorders, metabolic issues, and certain drug and alcohol problems.

Nerve damage or irritation

A cause of long-term hiccups is damage to, or irritation of, the vagus nerves or phrenic nerves. These nerves supply the diaphragm muscle.

Factors that may damage or irritate these nerves include:

• A hair or something else in your ear touching your eardrum.
• A tumor, cyst or growth on the thyroid gland in your neck.
• Stomach acid that backs up into your esophagus, the muscular tube that delivers food from your mouth to your stomach.
• Sore throat or laryngitis.

Central nervous system disorders

A tumor or infection in your central nervous system or damage to your central nervous system due to an injury can disrupt your body's normal control of the hiccup reflex.

Examples include:

• Inflammation of the brain, which also is known as encephalitis.
• Inflammation of the membranes that surround the brain and spinal cord, which also is known as meningitis.
• Multiple sclerosis, which is the hardening of tissue in the brain or spinal cord that can result in paralysis or tremors.
• Stroke.
• Serious brain injury.
• Tumors.

Metabolic issues

Long-term hiccups may result when your body's metabolism doesn't work properly.

Examples of metabolic issues include:

• Diabetes.
• Electrolyte imbalance, which is when your levels of potassium, sodium and other electrolytes are too high or too low.
• Kidney disease.

Certain drugs and alcohol issues

Use of certain drugs or problems with alcohol may cause long-term hiccups.

Examples include:

• Medicines that cause you to feel relaxed and sleepy, such as sedatives or other drugs used for anesthesia.
• A steroid called dexamethasone, which is used to relieve inflammation in conditions such as arthritis, asthma and kidney problems.
• Other steroids.
• Alcohol use disorder.

Risk factors

Males are much more likely to develop long-term hiccups than females. Other factors that may increase your risk of hiccups include:

• Mental or emotional issues. Anxiety, stress and excitement have been linked with some cases of hiccups.
• Surgery. Some people develop hiccups after general anesthesia or procedures that involve organs in the stomach area.

Complications

Ongoing hiccups may interfere with eating, drinking, sleeping and speaking. Hiccups also can worsen pain.

Diagnosis

During the physical exam, your health care provider may perform a neurological exam to check your:

• Balance and coordination.
• Muscle strength and tone.
• Reflexes.
• Sight and sense of touch.

If your health care provider thinks that an underlying medical condition may be causing your hiccups, the provider may recommend one or more of the following tests.

Lab tests

Samples of your blood may be checked for signs of diabetes, infection or kidney disease.

Imaging tests

Imaging tests may be able to detect issues inside your body that may be affecting your diaphragm or the nerve that controls your diaphragm, called the phrenic nerve. Or these tests may show issues with a main nerve in your nervous system, called the vagus nerve. Imaging tests may include a chest X-ray, a CT or an MRI.

Endoscopic tests

These procedures use a thin, flexible tube called an endoscope that contains a tiny camera that is passed down your throat and into your esophagus, sometimes called your food pipe. The purpose is to check for issues in your esophagus or your windpipe.

Treatment

Most cases of hiccups go away on their own without medical treatment. If an underlying medical condition is causing your hiccups, treating that condition may stop the hiccups.

If your hiccups last longer than two days, medicines or certain procedures may be needed.

Medicines

Drugs used to treat long-term hiccups include baclofen, chlorpromazine and metoclopramide.

Procedures

If less invasive treatments aren't effective, your health care provider may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups.

Another option is to surgically implant a battery-operated device to deliver mild electrical stimulation to your vagus nerve. This procedure is most commonly used to treat epilepsy, but it also has helped control long-term hiccups.

Lifestyle and home remedies

There's no certain way to stop hiccups. But if your hiccups last longer than a few minutes, these home remedies may provide relief, although they are not proven:

• Breathe into a paper bag.
• Gargle with ice water.
• Hold your breath.
• Sip cold water.

If you have ongoing hiccups, lifestyle changes may help, such as:

• Avoiding carbonated beverages and foods that give you gas.
• Eating smaller meals.

Alternative medicine

When long-term hiccups don't respond to other remedies, alternative treatments, such as hypnosis and acupuncture, may help.

Preparing for an appointment

You may initially talk with your family health care provider about your ongoing hiccups. Your health care provider may refer you to a specialist if you have long-term or severe hiccups.

What you can do

Consider writing a list that includes:

• Detailed descriptions of your symptoms.
• Information about health problems you've had.
• Information about your parents' or siblings' health problems.
• The medications and dietary supplements you take.
• Questions you want to ask your health care provider.

What to expect from your health care provider

Your health care provider may ask:

• When did your hiccups start?
• How often do they happen?
• What worsens or relieves them?
• What medicines are you taking?
• Have you had a sore throat or earache?
• Do you have indigestion symptoms or bloating?
• Have you had a sore throat or changes in your voice?
• Have you had chest pain, a cough or difficulty breathing?
• Do you have headaches or other symptoms that might be linked to your brain or nervous system?

Preparing for questions will help you make the most of your time with your health care provider.