Humza Khizer

Learn effective ways to deal with hiccups with Meri Sehat. Explore tips for relief and prevention.

Had Enough Of The Hiccough?

Introduction

Can you imagine yourself hiccupping nonstop for a day? How about several years? Well, Kevern Koskovich did. Except it wasn&rsquo;t just an imaginary scenario. He really did hiccup for 68 years straight!

Mr. Koskovich met with an accident after which he was unable to stop the process and had to learn a different kind of breathing so that he was able to speak without making a weird noise. While we don&rsquo;t even pay attention to such small episodes in our life, this man spent most of his life hiccupping. 
&nbsp;

Hiccups or hiccoughs are referred to as &ldquo;singultus&rdquo; in scientific terminology. Singulutus is a Latin word that is defined as &ldquo;a gasp&rdquo; or &ldquo;a sob&rdquo;. It is a temporary state that almost everyone goes through in their lives.

Generally, a hiccup is nothing to be concerned about. If you have an episode of the persistent and harder-to-control hiccup variant, though, it&rsquo;s alarming as hiccups can complicate your health. One of these extreme complications includes respiratory alkalosis, i.e., your blood becomes less acidic and more alkaline due to an imbalance in your gaseous exchange in the lungs<a href="#accordion">[2]</a>. 
&nbsp;

Clinically, a hiccup can be explained as an immediate contraction of your diaphragm and intercostal muscles, followed by the closure of your larynx right after. As the air rushes in, it makes a noise, which sounds like a &quot;hic&quot; to your ears.

A hiccup is a self-limiting disorder. However, its persistent variant can prolong for two or more days. If your hiccupping episodes last more than 2 months, it is called an intractable hiccup.

Your nervous system is responsible for this phenomenon; to be exact, the peripheral phrenic, vagal, and sympathetic pathways along with the involvement of your midbrain. Therefore, any form of irritant, which can be in the form of a physical or chemical factor, swelling, and neoplasia (cancerous evolvement) in any of these nervous pathways cause hiccups<a href="#accordion">[1]</a>. 
&nbsp;

Even after understanding the mechanism and physiology of hiccups, it is not possible to predict hiccups. There is a good chance some of you will be having one reading this right now! Every time you get a hiccup, as mentioned earlier, there is a contraction involved. And with each contraction, your chest or throat tightens up a bit, making that characteristic sound. Good thing it is only a matter of minutes before you stop sounding like that. 
&nbsp;

Understanding The Phenomenon of Hiccups

Clinically, hiccups are classified based on their<a href="#accordion">[5]</a>.

1. Transient Hiccups: Episodes of hiccups that last mere seconds or minutes. Transient hiccups don&rsquo;t have a known reason.

2. Persistent Hiccups: These hiccup sessions last more than 48 hours. Unlike transient hiccups, persistent hiccups occur most probably due to gastroesophageal diseases.

3. Recurrent Hiccups: Recurrent hiccups usually last more than a transient episode along with an occasional repetition. 
&nbsp;

However, to make things easier, hiccups are divided into two broad types: short-term and long-term<a href="#accordion">[3]</a>.

<ul>
	<li>
	<h5>Short-Term Hiccups</h5>
	</li>
</ul>

There are various causes of hiccups, which have been studied. To date, there is not much information available on the triggers. The most common causes of short-term hiccups can include:

1. <a href="https://merisehat.pk/article/fasting-feasting-tips-on-how-to-avoid-overeating-in-ramzan">Overeating</a>

2. Consuming spicy food

3. Drinking excessive alcohol

4. Consuming carbonated beverages, like sodas

5. Eating very hot or very cold food items

6.&nbsp; An immediate change in air temperature

7.&nbsp; Aerophagia, which is essentially swallowing too much air

8.&nbsp; Swallowing air while chewing gum

9.&nbsp; Being excited excessively or being stressed out emotionally 
&nbsp;

Risk factors that aid in the onset of hiccups include:

<ol>
	<li>&nbsp;Male gender</li>
	<li>&nbsp;Strong mental or emotional responses, from being suddenly anxious to uncontrollably excited</li>
	<li>&nbsp;A previous surgery, especially an abdominal surgery</li>
	<li>&nbsp;Recent exposure to general anesthesia 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Long-Term Hiccups</h5>
	</li>
</ul>

Hiccups that persist for more than 48 hours are termed persistent and the ones lasting longer than 2 months are referred to as intractable and collectively called long-term hiccups. These variants of long-term hiccups are grouped based on the irritant that causes them. 
&nbsp;

1.&nbsp;Nerve Injury Or Irritation

Mostly the onset of persistent hiccups is caused by an injury or irritation to either your vagus or the phrenic nerve. These nerves are essentially responsible for controlling the movement of your diaphragm. The irritants that can affect these nerves are:

<ul>
	<li>A foreign object, which may get lodged in your ear and irritate your eardrum</li>
	<li>Soreness in your throat</li>
	<li>Goiter, i.e., unusual growth of your thyroid</li>
	<li>Gastroesophageal reflux disease, i.e., backflow of stomach acid in the food pipe</li>
	<li>A tumor of the esophagus 
	&nbsp;</li>
</ul>

2.&nbsp;Central Nervous System Damage

Some other causes that can cause the onset of hiccups can be related to your central nervous system (CNS). Your CNS includes your brain and the spinal cord. If your CNS gets injured due to any reason, you&rsquo;ll essentially be unable to stop the hiccups.

Some of the CNS-related conditions that may lead to persistent hiccups include:

<ul>
	<li>Stroke</li>
	<li>Multiple sclerosis</li>
	<li>A tumor</li>
	<li>Trauma to the head or an injury to the brain</li>
	<li>Infection or swelling of the brain or the layers protecting the brain</li>
	<li>Hydrocephalus, i.e., a buildup of the fluid in the brain</li>
	<li>Neurosyphilis and other brain infections 
	&nbsp;</li>
</ul>

Long-term hiccups can also be caused by:

<ul>
	<li>Alcohol misuse</li>
	<li>Tobacco use</li>
	<li>A reaction that may have been caused by anesthesia after a surgery</li>
	<li>Medications, including barbiturates, steroids, and tranquilizers</li>
	<li>An imbalance in your electrolyte levels</li>
	<li>Diabetes</li>
	<li>Kidney failure</li>
	<li>Arteriovenous malformation, i.e., a medical condition in which the arteries and veins are tangled up in the brain</li>
	<li>Parkinson&rsquo;s disease</li>
	<li>Use of cancer and other chemotherapy medications 
	&nbsp;</li>
</ul>

Hiccups normally do not need any medical attention as they are self-resolving. However, if the hiccups last longer than 48 hours, it&rsquo;s important to consult a healthcare provider. You can expect them to ask the following questions:

<ul>
	<li>When did your hiccups initiate?</li>
	<li>How frequently do you get the episodes?</li>
	<li>Do they stop?</li>
	<li>What were you exactly doing when you got the episode and is there a pattern? 
	&nbsp;</li>
</ul>

Your healthcare provider may need to do an examination as well, which may include checking your:

<ul>
	<li>Reflexes</li>
	<li>Balance</li>
	<li>Coordination</li>
	<li>Eyesight</li>
	<li>Sense of touch</li>
	<li>Muscle strength</li>
	<li>Muscle tone 
	&nbsp;</li>
</ul>

Hiccups can also exist due to secondary causes, which means that there&rsquo;s an underlying pathology that must be setting it off. A doctor will order the following assessments:

<ul>
	<li>A Complete Blood Picture to evaluate any signs of infections, kidney disease, or diabetes</li>
	<li>Imaging Tests, including an X-ray, computerized tomography scan, or magnetic resonance imaging scan to evaluate if any structural irregularities may be disrupting the phrenic, vagus nerves, or even the diaphragm</li>
	<li>An Endoscopy can also be performed by your healthcare provider, in which an endoscope (a flexible tube with a small camera at one end) is passed down your throat to assess your windpipe or esophagus</li>
	<li>An Electrocardiogram is also used to report any heart-related causes by measuring the electrical activity of your heart 
	&nbsp;</li>
</ul>

Conclusion

Even though hiccups cannot be termed as a disease essentially, they can still be treated. As the main etiology of hiccups is not sure, these remedies may or may not work<a href="#accordion">[4]</a>:

<ul>
	<li>Drinking water quickly</li>
	<li>Eat granulated sugar, dry chunks of bread, or crushed ice</li>
	<li>Softly pull your tongue</li>
	<li>Induce gag reflex by shoving a finger down your throat</li>
	<li>Softly rub your eyeballs</li>
	<li>Do water gargles</li>
	<li>Hold your breath briefly</li>
	<li>Breath into a paper bag; make sure not to use a plastic bag 
	&nbsp;</li>
</ul>

Hiccups that last for a long time can be treated with medication. Prescription drugs used for long-lasting hiccups include:

1. Gabapentin

2. Baclofen

3. Chlorpromazine 
&nbsp;

Only in rare instances, you&rsquo;d need medical intervention to treat hiccups. Whenever you do, medications are prescribed to prevent them. For instance, hiccups that are anesthesia-related can be prevented by taking the medicine metoclopramide before being sedated. Similarly, taking a steroid with ramosetron may help in preventing chemotherapy-cause hiccups. 
&nbsp;

To prevent mild variants of hiccups, i.e., hiccups that go away in a short interval, you can always try to avoid the following factors:

<ul>
	<li>Eat or drink too quickly</li>
	<li>Drink carbonated beverages or alcohol</li>
	<li>Eat excessively</li>
	<li>Be stressed, including fear and excitement</li>
	<li>Over-stretch your neck</li>
	<li>Take drugs, especially those for anxiety, such as benzodiazepines</li>
	<li>Drink a very hot or very cold drink</li>
	<li>Inhale toxic fumes 
	&nbsp;</li>
</ul>

It seems like an unimportant event in your day, and you may come up with sensible reasoning for it like a spicy ramen, it is crucial to track if your hiccups are getting out of control. So next time you are not able to shut the hiccup, you might want to go get yourself assessed. 
&nbsp;

Key Takeaways

<ul>
	<li>Hiccups or hiccoughs are also known as singultus.</li>
	<li>Even though a hiccup is nothing to be concerned about, the persistent and harder-to-control hiccup variants can be alarming as they complicate your health.</li>
	<li>Clinically, a hiccup can be explained as an immediate contraction of your diaphragm and intercostal muscles, followed by the closure of your larynx right after. As the air rushes in, it makes a noise that sounds like a &quot;hic.&quot;</li>
	<li>A hiccup is normally a self-limiting disorder. If it prolongs even after two days, it is referred to as the persistent variant. If your hiccupping episodes last more than 2 months, it is called an intractable hiccup.</li>
	<li>The nerves responsible for this phenomenon are peripheral phrenic, vagal, and sympathetic pathways along with the involvement of your midbrain.</li>
	<li>Even after understanding the mechanism and physiology of hiccups, it is not possible to predict hiccups.</li>
	<li>The most common causes of short-term hiccups include overeating, consuming spicy food, drinking excessive alcohol, consuming carbonated beverages, like sodas, and eating very hot or very cold food items.</li>
	<li>Risk factors that aid in the onset of hiccups include the male gender and if you go through strong mental or emotional responses.</li>
	<li>Mostly the onset of persistent hiccups is caused by an injury or irritation to either your vagus or the phrenic nerve.</li>
	<li>The irritants that can affect these nerves are foreign objects that may get lodged in your ear and irritate your eardrum and soreness in your throat.</li>
	<li>If your CNS gets injured due to any reason, you are essentially unable to stop the hiccups. Some of these conditions include multiple sclerosis and stroke.</li>
	<li>Long-term hiccups may also be caused by alcohol misuse and tobacco use.</li>
	<li>Hiccups that do not last up to 48 hours do not normally need any medical attention as they are self-resolving.</li>
	<li>Your healthcare provider may need to do an examination as well, which may include checking your reflexes, balance, and coordination.</li>
	<li>Hiccups that last for a long time can be treated by medication. Prescription drugs used for long-lasting hiccups include gabapentin, baclofen, and chlorpromazine.</li>
	<li>Hiccups that are anesthesia-related can be prevented by taking the medicine metoclopramide before being sedated.</li>
	<li>To prevent the mild variant of hiccups, you can always try to avoid eating or drinking too quickly, drinking carbonated beverages or alcohol, and eating excessively. 
	&nbsp;</li>
</ul>

[1] Chang, F. Y., & Lu, C. L. (2012). Hiccup: mystery, nature, and treatment. Journal of neurogastroenterology and motility, 18(2), 123–130.

[2] Arora, C. D., Wanchoo, J., & Khera, G. (2017). Hiccups in the Neuro-Critical Care Unit: A Symptom Less Studied?. Journal of Medical Research and Innovation, 1(2), AX1-AX3.

[3] Giorgi A. What causes hiccups, and how do you treat them?

[4] Hiccups: Causes & treatment. Cleveland Clinic.

[5] Brañuelas Quiroga, J., Urbano García, J., & Bolaños Guedes, J. (2016). Hiccups: a common problem with some unusual causes and cures. The British journal of general practice: the journal of the Royal College of General Practitioners, 66(652), 584–586.