Hiccups
Everyone knows hiccups, and almost every bout settles by itself: a few minutes, sometimes half an hour, and you forget it happened.
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Medicines commonly prescribed for Hiccups
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: INJECTABLE, 10 mg metoclopramide/2 mlActive substance: metoclopramideManufacturer: Sanofi Aventis S.A.Prescription requiredDosage form: INJECTABLE, 5 mg chlorpromazine/mlActive substance: chlorpromazineManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: INJECTABLE, 5 mg/mlActive substance: metoclopramideManufacturer: Laboratorios Basi Industria Farmaceutica S.A.Prescription required
Everyone knows hiccups, and almost every bout settles by itself: a few minutes, sometimes half an hour, and you forget it happened. It is precisely because they are so harmless that the other half of the subject is worth knowing. Hiccups that carry on for a day or more are no longer a household nuisance but a symptom, and sometimes there is an illness behind them that the person has yet to discover. The line between those two stories is drawn by time, and it is worth remembering where it falls.
Why the diaphragm loses its rhythm
The diaphragm is the flat muscle between the chest and the abdomen, and the main engine of breathing. Hiccups begin when it contracts sharply of its own accord, together with the muscles between the ribs. Air is pulled in with a jerk, but at that same moment the vocal cords snap shut, which is what makes the short sound.
All of this is governed by a reflex arc: sensory fibres of the phrenic and vagus nerves run up to the brainstem and back down to the diaphragm. Irritation anywhere along that circuit can set it off. The arc is long and passes through the neck, the chest and the upper abdomen, which is why the list of possible causes is so wide, from a mouthful of cold water to an illness that seems to have nothing to do with breathing.
What sets off ordinary hiccups
A short bout at home usually has a simple explanation involving the stomach and the oesophagus, which sit directly under the diaphragm and nudge it easily.
- Overeating, or eating quickly and dry.
- Fizzy drinks and anything that makes you swallow extra air: chewing gum, drinking through a straw, talking with your mouth full.
- A sudden temperature change inside, something very cold straight after something hot.
- Alcohol, especially spirits taken in one go.
- Smoking.
- Nerves, a fright, laughter, strong feelings and stress on its own.
Often no cause is found at all, and that is perfectly normal. If the hiccups lasted a few minutes and have not come back, there is nothing to look for.
What you can try at home
None of the home remedies has solid evidence behind it: hiccups stop by themselves, so it is impossible to tell whether the trick worked or the time was simply up. Even so, most of them are harmless and there is no reason not to try. They all share the same idea, either to raise the carbon dioxide in the blood for a moment or to give the vagus nerve something else to do.
- Sip cool water slowly.
- Hold your breath for a few seconds, calmly and without straining.
- Pull your knees up to your chest and lean forwards.
- Swallow a teaspoon of sugar or a piece of lemon slowly.
- Gargle gently with water.
What is better avoided. Do not breathe into a bag: the advice has spread widely, but there is no way to control how long the breath is held, and the manoeuvre is not safe for anyone with heart or lung disease. Do not deliberately startle someone with hiccups; a fright does not cure anything, and in an older person or someone with heart disease it is an unnecessary strain. Do not press on your own eyeballs or massage the side of your neck: those are manoeuvres on the vagus nerve, and nobody should perform them on themselves. Spirits, vinegar and hot chilli do not stop hiccups, and they do irritate the oesophagus further.
Hiccups in babies and small children
Babies hiccup often, sometimes several times a day, and it is almost always normal: the diaphragm is still immature and air is swallowed easily during a feed. The baby is usually settled, feeding and sleeping as usual. What helps is not a trick but the way feeding is organised: smaller feeds, pauses, holding the baby upright for a while afterwards, and checking the latch at the breast or the size of the hole in the teat.
Adult remedies are not used on children. A child should not be given spoonfuls of sugar, pieces of lemon, ice or any solid food "for hiccups", because of the risk of choking. Do not ask a child to hold their breath or breathe into a bag, and do not startle them. Honey is not given to babies under one year old at all.
Have a child seen if hiccups stop them feeding or sleeping, if they come with forceful vomiting, crying during feeds, poor weight gain, coughing or a change in colour around the lips, or if they go on for long stretches day after day. In children, persistent hiccups most often turn out to be reflux.
When hiccups stop being an everyday matter
Hiccups lasting longer than 48 hours are a reason to see a doctor. The limit is arbitrary but universally used: beyond it hiccups count as persistent and need an explanation. A bout that stretches on for a month or more is called intractable. Hiccups like that are genuinely exhausting; they get in the way of eating, sleeping and speaking, and lead to weight loss and real debility, and in the great majority of cases there is a definite cause behind them.
What turns up can be very varied, because the reflex arc runs through half the body:
- reflux, hiatus hernia, inflammation or narrowing of the oesophagus, stomach ulcer;
- irritation of the diaphragm itself or of neighbouring organs: pleurisy, pneumonia, an abscess under the diaphragm, pancreatitis, disease of the liver or gallbladder;
- anything pressing on the phrenic or vagus nerve in the neck or chest: an enlarged thyroid, enlarged lymph nodes, a tumour in the chest or lung, an aneurysm;
- damage to the brainstem: stroke, multiple sclerosis, a tumour, inflammation of the linings of the brain. The brainstem is exactly where the reflex closes, which is why persistent hiccups can be one of its earliest signs;
- metabolic problems: kidney failure and uraemia, poorly controlled diabetes, low sodium or potassium in the blood;
- medicines: some steroids and other hormone treatments, anaesthetic drugs, certain cancer treatments and sedatives.
Signs that cannot wait
Call an ambulance on the single European number 112 if hiccups appear alongside sudden weakness or numbness in an arm and a leg, a drooping face, slurred speech, double vision, dizziness with loss of balance, difficulty swallowing or a thunderclap headache. That combination points to the brainstem and needs help immediately, not tomorrow.
See a doctor the same day if hiccups come with chest or abdominal pain, breathlessness, vomiting or fever, if they are stopping you eating and drinking, or if they began after a recent operation.
What the doctor will look for
The first question is how long it has gone on and what happened just before it started: a new medicine, an operation, an injury, a flare of heartburn. The doctor will examine the abdomen, listen to the lungs and heart, look at the throat and neck and check the neurological reflexes. How far the tests go depends on what is found: usually blood tests including kidney function and electrolytes, a chest X-ray, endoscopy if the oesophagus or stomach is suspected, and brain imaging if anything shows up on neurological examination.
Treatment is aimed first at the cause: adjusting treatment for reflux, stopping or swapping the medicine responsible, or treating a pneumonia usually settles the hiccups as well. If no cause is found and the hiccups are wearing the person down, a doctor may prescribe a medicine that acts on the reflex arc itself; drugs from several groups are used for this, including antipsychotics, anticonvulsants and prokinetics that speed up stomach emptying. They do not work for everyone, they are chosen case by case, and they are only ever started by a doctor.
Online consultation
Hiccups are one of those subjects where the story matters more to a doctor than the examination: when it started, what happened the day before, how it relates to meals and to body position, and what medicines you take. All of that can be discussed calmly online. In a consultation, an Oladoctor doctor will help you work out whether your case falls within the ordinary, suggest what to change in your diet and routine if reflux is suspected, go through your medicines in case one of them is responsible, and explain which tests make sense and which specialist to see next. If what you describe needs urgent face-to-face care, you will be told so plainly.
This material is for information only and does not replace medical advice.
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