Hiccups are caused by the diaphragm involuntarily contracting. Some common causes for this contraction include drinking carbonated beverages, eating a large meal, swallowing too much air, or stress.
Hiccups are repetitive, uncontrollable contractions of the diaphragm, the muscle structure just below your lungs.
The diaphragm marks the boundary between your chest and abdomen, and it also regulates breathing. When your diaphragm contracts, your lungs take in oxygen. When your diaphragm relaxes, your lungs release carbon dioxide.
The diaphragm contracting out of rhythm is what causes hiccups. Each spasm of the diaphragm makes the larynx (voice box) and vocal cords close suddenly. This results in a sudden rush of air into the lungs. Your body reacts with a gasp or chirp, creating the sound characteristic of hiccups.
There’s no way to anticipate hiccups. With each spasm, there’s usually a slight tightening of the chest or throat prior to you making the distinctive hiccup sound.
Most cases of hiccups start and end abruptly, for no noticeable reason. Episodes generally last only a few minutes.
Did you know?
The medical term for hiccups is singultus.
Numerous causes of hiccups have been identified. However, there’s no definitive list of triggers. Hiccups often come and go for no apparent reason.
Common causes of short-term hiccups may include:
- eating spicy food
- consuming alcohol
- drinking carbonated beverages, like sodas
- consuming very hot or very cold foods
- a sudden change in air temperature
- aerophagia, which is swallowing too much air
- swallowing air while chewing gum
- excitement or emotional stress
There are several factors that can increase your likelihood of developing hiccups. You may be more susceptible if you:
Most hiccups aren’t an emergency or anything to worry about. However, a prolonged episode can be uncomfortable and disruptive to your daily life.
Contact a doctor if you have hiccups that last longer than 2 days. The doctor can determine the severity of your hiccups in relation to your overall health and other conditions.
There are numerous options for treating hiccups. Typically, a short-term case of hiccups will take care of itself. However, the discomfort may make waiting out hiccups unbearable if they last longer than a few minutes.
Not all of these have been proven to stop hiccups, but you can try the following potential treatments for hiccups at home:
- Breathe into a paper bag.
- Eat a teaspoon of granulated sugar.
- Hold your breath.
- Drink a glass of cold water.
- Pull on your tongue.
- Lift your uvula, which is the fleshy piece of tissue that’s suspended above the back of your throat, with a spoon.
- Attempt to purposefully gasp or belch.
- Bring your knees to your chest and maintain this position.
- Try the Valsalva maneuver by shutting your mouth and nose and exhaling forcibly.
- Relax and breathe in a slow, controlled manner.
Treating any underlying causes of your hiccups will usually make them go away.
If your hiccups last for a while and have no obvious cause, a doctor may recommend several anti-hiccup medications. The more commonly used medications include:
- antipsychotic medications chlorpromazine and haloperidol
- benzodiazepines, a class of tranquilizers
- seizure medications, such as gabapentin (Neurontin)
- diphenhydramine (Benadryl), an antihistamine
- metoclopramide (Reglan), an anti-nausea drug
- baclofen, a muscle relaxant
- nifedipine (Procardia, Procardia XL), a blood pressure medication
The Food and Drug Administration (FDA) hasn’t approved any prescription medications for the treatment of hiccups. If a doctor recommends any of the prescription medications above, it’ll be an example of off-label drug use.
Off-label drug use
Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use them to treat their patients. So your doctor can prescribe a medication however they think is best for your care.
A doctor may perform a carotid sinus massage to help stop long lasting hiccups. This involves rubbing the main carotid artery in the neck.
There are also more invasive options, which can be used to end extreme cases of hiccups. They include:
- nasogastric intubation, which is the insertion of a tube through your nose into your stomach
- gastric lavage (stomach pumping)
- an anesthetic injection to block the phrenic nerve, which is located in the diaphragm
- surgical implantation of a diaphragmatic pacemaker, a battery-powered device that stimulates your diaphragm and regulates breathing
Hiccups that last longer than 48 hours are considered persistent. Hiccups that last longer than 2 months are considered intractable, or difficult to manage.
These types of long-term hiccups are categorized by the type of irritant that caused the episode.
Nerve injury or irritation
The majority of persistent hiccups are caused by injury or irritation to either the vagus or phrenic nerve. The vagus and phrenic nerves control the movement of your diaphragm. These nerves may be affected by:
- irritation of your eardrum, which may be caused by a foreign object
- throat irritation or soreness
- gastroesophageal reflux disease (GERD)
- an esophageal cyst or tumor
Central nervous system (CNS) damage
Other causes of hiccups may involve the central nervous system (CNS). The CNS consists of the brain and spinal cord. If the CNS is damaged, your body may lose the ability to control hiccups.
CNS damage that may lead to persistent hiccups includes:
- multiple sclerosis (MS)
- head trauma or brain injury
- meningitis and encephalitis, which are infections that can cause swelling in the brain
- hydrocephalus, or the accumulation of fluid on the brain
- neurosyphilis and other brain infections
Hiccups that last for longer periods can also be caused by:
- misuse of alcohol
- tobacco use
- a reaction to anesthesia after surgery
- certain classes of medications, including barbiturates, steroids, and tranquilizers
- electrolyte imbalance
- kidney failure
- arteriovenous malformation, a condition in which arteries and veins are tangled in the brain
- Parkinson’s disease
- cancer and chemotherapy treatments
Sometimes, a medical procedure can accidentally cause you to develop long-term hiccups. These procedures are used to treat or diagnose other conditions and include:
- use of catheters to access the heart muscle
- placement of an esophageal stent to prop open the esophagus
- bronchoscopy, in which a doctor uses a thin, lighted tube with a camera on the end to examine your lungs and airways
- tracheostomy, or the creation of a surgical opening in the neck to allow breathing around an airway obstruction
If the cause of your hiccups is unclear, a doctor may recommend tests. These can help detect any underlying disease or condition.
The following tests may be useful in determining the cause of persistent or intractable hiccups:
- blood tests to identify signs of infection, diabetes, or kidney disease
- liver function tests
- imaging of the diaphragm with a chest X-ray, CT scan, or MRI
- echocardiogram to assess heart function
- endoscopy, in which a doctor uses a thin, lighted tube with a camera on the end to investigate your esophagus, windpipe, stomach, and intestine
A long-term episode of hiccups can be uncomfortable and even harmful to your health. If left untreated, prolonged hiccups can disturb your sleeping and eating patterns, leading to:
There’s no proven method for preventing hiccups. However, if you experience hiccups frequently, you can try to reduce your exposure to known triggers.
Following this advice may also help reduce your susceptibility to hiccups:
Hiccups have a wide range of possible triggers, from drinking soda and eating certain foods to medication use and underlying conditions. A number of possible treatments are also available.
In rare instances, hiccups can last longer than 48 hours. If your hiccups last longer than 48 hours, don’t respond to treatment, or you aren’t sure what’s causing them, see a doctor for a diagnosis.
Also, see a doctor or seek emergency help if you’re having numbness and coordination issues alongside your persistent hiccups. These may be symptoms of a stroke.