Hiccups

What are hiccups?

A hiccup is a sudden, involuntary contraction (spasm) of the diaphragm muscle. When the muscle spasms, the vocal cords snap shut, producing the hiccup sound.
Hiccups are often rhythmic. They are usually just a temporary minor annoyance, but prolonged hiccups may signal a major medical problem.

What causes hiccups?

Most of the time, there is no obvious cause for hiccups. However, there are some common known causes of hiccups.
Some causes of hiccups include:

• Eating too quickly and swallowing air along with foods.
  
• Eating too much (fatty or spicy foods, in particular) or drinking too much (carbonated beverages or alcohol) can distend the stomach and irritate the diaphragm, which can cause hiccups.
  
• Any disease or disorder that irritates the nerves that control the diaphragm (such as liver disease, pneumonia, or other lung disorders).
  
• Abdominal surgery can also irritate the nerves that control the diaphragm, causing hiccups.
  
• Strokes or brain tumors involving the brain stem, and some chronic medical disorders (such as renal failure) have also been reported to cause hiccups.
  
• Some medications may also have hiccups as a side effect, for example:
  
  
  • medications for acid reflux
    
  • Most benzodiazepines, including diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan)
    
  • levodopa, nicotine, and ondansetron (Zofran)
    
• Noxious fumes can also trigger hiccups. 

What are the symptoms of hiccups?

Sudden, forceful movement of the diaphragm, that causes the hiccup sound, is the only symptom of hiccups.

When should I contact my doctor for hiccups?

Most cases of hiccups resolve themselves in a short period of time and are rarely a medical emergency. See your doctor if hiccups last more than three hours, or if they disturb your eating or sleeping habits.
If hiccups are associated with abdominal pain, fever, shortness of breath, vomiting, coughing up blood, or feeling as if your throat is going to close up, you should seek medical attention.

How are hiccups diagnosed?

Most of us know what a hiccup feels like and how to recognize it. In a medical setting, the diagnosis of hiccups is based on physical evaluation.
Blood tests or X-rays are usually not necessary unless your hiccups are a symptom of an associated medical condition.

What is the treatment for hiccups?

Home Remedies for Hiccups
There are numerous home cures for hiccups. You can try these methods at home to get rid of hiccups:
Methods that cause the body to retain carbon dioxide, which is thought to relax the diaphragm and stop the spasms which cause the hiccups:

• Hold your breath

Techniques that stimulate the nasopharynx and the vagus nerve, which runs from the brain to the stomach, and can decrease hiccupping:

• Drink a glass of water quickly
  
• Have someone frighten you
  
• Pull hard on your tongue
  
• Bite on a lemon
  
• Gargle with water
  
• Drink from the far side of a glass
  
• Use smelling salts
  
• Place one-half teaspoon of dry sugar on the back of your tongue. (This process can be repeated three times at two-minute intervals. Use corn syrup, not sugar, for young children.)

Medical Treatment
Most hiccups will stop on their own. Home remedies are generally sufficient to resolve hiccupping.
For persistent hiccups (lasting more than three hours) treatment varies.
A physician may prescribe medications for severe, chronic hiccups. Chlorpromazine (Thorazine) is usually the first-line medication prescribed for hiccups. Other medications used to treat hiccups include haloperidol (Haldol) and metoclopramide (Reglan).
Some muscle relaxants, sedatives, analgesics, and even stimulants have also been reported to help alleviate hiccup symptoms.
Phrenic nerve surgery (the nerve that controls the diaphragm) is a treatment of last resort. This treatment is rarely performed and used only in cases that do not respond to other treatments.

Are there any complications of hiccups?

Because most cases of hiccups resolve themselves either spontaneously or with self-administered treatment, complications are extremely rare.
In severe and persistent cases, where hiccups disturb eating and sleeping patterns, weight loss or sleep disturbances may occur.
More uncommonly, cardiac arrhythmias and gastroesophageal reflux have been noted in severe cases of hiccups.

Can hiccups be prevented?

Hiccups cannot always be prevented. Avoiding overeating, eating too quickly, or drinking too much can help prevent hiccups.

Hiccups At A Glance

• A hiccup is a sudden, involuntary contraction (spasm) of the diaphragm muscle. When the muscle spasms, the vocal cords snap shut, producing the hiccup sound.
  
• Common causes of hiccups include eating too quickly, eating or drinking too much, diseases that irritate the nerves that control the diaphragm, abdominal surgery, strokes or brain tumors, noxious fumes, and certain medications.
  
• Most cases of hiccups resolve themselves in a short period of time and are rarely a medical emergency. See your doctor if hiccups last more than three hours, or if they disturb your eating or sleeping habits.
  
• Home remedies for hiccups include: holding your breath, drinking a glass of water quickly, pulling hard on your tongue, biting on a lemon, gargling with water, and using smelling salts.
  
• A physician may prescribe medications such as chlorpromazine (Thorazine), haloperidol (Haldol), and metoclopramide (Reglan) for severe, persistent hiccups.
  
• Avoid overeating, eating too quickly, or drinking too much to help prevent hiccups.

References:

eMedicineHealth.com, "Hiccups."

Medline Plus, National Library of Medicine, National Institutes of Health, "Hiccups."

The Scientific American, "What Causes Hiccups?"

emedicine.com, "Hiccups: Treatment and Medications."

Medical Author:

John P. Cunha, DO, FACOEP

Medical Editor:

Melissa Conrad Stöppler, MD

Source:Medicinenet.com.