Q: I seem to get the hiccups every couple of months. Once they lasted almost an hour. Why does this happen? A: Hiccups are involuntary contractions, or spasms, of the diaphragm and the muscles between the ribs, or the intercostal muscles, that cause a sudden inspiration.
Q: I seem to get the hiccups every couple of months. Once they lasted almost an hour. Why does this happen?
A: Hiccups are involuntary contractions, or spasms, of the diaphragm and the muscles between the ribs, or the intercostal muscles, that cause a sudden inspiration. These spasms usually occur five, 10 or even 20 times per minute.
For unknown reasons, hiccups usually involve only one side of the diaphragm and intercostal muscles –– the left side is more common than the right.
Although most cases of hiccups last only minutes, a bad bout of hiccups can last up to a couple of days. Persistent hiccups can last up to a month, and intractable hiccups persist for over a month.
Hiccups are thought to be a reflex from stimulation of the phrenic and/or vagus nerves, which are the nerves that stimulate the diaphragm. The signals from this stimulation are then centrally processed in the brain, and a signal sent to the diaphragm and intercostal muscles to hiccup. I have not seen any research indicating there is benefit from this hiccup reflex.
Direct irritation of the diaphragm is the most common cause of the stimulation of the hiccup reflex, and these "benign hiccups" rarely last more than minutes to hours, and they very rarely last more than days. This typically happens from direct pressure on the diaphragm from an overfull or gas-bloated stomach, which can result from too much soda or air getting into the stomach by other means.
Other stimulators of the hiccup reflex include:
A foreign body coming in contact with the ear drum, stimulating a branch of the vagus nerve.
Inflammation to the throat/larynx irritating the laryngeal nerve, a branch of the vagus nerve.
Irritation of the laryngeal or phrenic nerves from a neck mass like a big thyroid, tumor or other cause.
Chest masses pressing on the diaphragm or stimulating the nerves.
Psychogenic factors, such as stress, anxiety and others.
Signals to the phrenic and/or vagus nerves may originate directly from the brain in some cases (central causes of hiccups). Cases of intractable hiccups increase the suspicion of central causes of hiccups. These include:
Infections, such as toxoplasmosis in immune-compromised patients.
Brain masses, such as, tumors.
Irritation from toxic substances, such as alcohol or even some anesthesia medications.
It is not uncommon for a fetus to have hiccups, especially during the third trimester. This is easily appreciated by the mom –– and those who put their hands on mom's belly at the right time –– and no treatment is needed.
When the hiccups have been going on for less than a couple of days but long enough for a patient to seek medical help, a history and physical is all that is initially indicated. This allows assessment of the risk of one of the less common but more worrisome causes discussed above.
For the uncommon patient who has long-duration hiccups or who has been assessed to be at a high risk, blood tests, a chest X-ray, a CT scan of the head and/or other tests, such as a CT of the neck or chest, may be needed.
Since the most common culprit of hiccups is over-distention of the stomach, causing diaphragm irritation, there are some "folklore" remedies, such as drinking or gargling water, holding one’s breath to have the diaphragm push back or swallowing some sugar to stimulate the naso-pharynx. Or you can try mechanical maneuvers to decrease diaphragm irritation, such as leaning forward or pulling the knees up to the chest.
Persistent cases that do not respond to these techniques may require medications. The most common one is chlorpromazine. There are reported rare cases of patients who need very aggressive treatment for their hiccups; surgery to place an electronic breathing pacemaker inside the body has been successful for some patients.
If you have long-duration hiccups, you should see your health care provider to be evaluated. Although most patients only require a thorough history and physical evaluation, some cases of hiccups may be a clue to some more serious underlying condition.
Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.