Introduction

Hiccups start suddenly, and usually last for only a few minutes. You might hiccup anywhere between 4 to 60 times a minute. Hiccups will usually stop on their own.

Hiccups are a reflex action; this means you do not have any control over them. They do not seem to have a useful purpose and are more common in the evening.

Men and women are equally affected by hiccups. However, persistent hiccups (lasting for more than 48 hours) are more common in men. Persistent hiccups can be very tiring and upsetting, and can make eating and drinking difficult. They are however rare, and are sometimes caused by an underlying disease.

Causes

Hiccups are caused by your diaphragm squeezing unintentionally. The trigger may be unknown but sometimes a trigger can be identified - for example:

• stretching of the stomach after rapid eating, drinking, or swallowing air or carbonated drinks or soft drinks,
• indigestion, usually due to eating hot and spicy food,
• sudden emotional excitement, upset or surprise, including laughing,
• sudden change of air temperature, for example taking a cool shower,
• very hot or cold food or drink, and
• alcohol, or excess smoking.

Most people have short bouts of hiccups now and again. Persistent hiccups (lasting more than 48 hours) may occur for no apparent reason but usually occur together with heartburn or acid reflux.

On very rare occasions the underlying cause can be due to a serious condition, such as:

• irritation of the diaphragm by infection, by cancer spread from elsewhere, or by a hiatus hernia (when part of the stomach pushes through the diaphragm),
• irritation of the phrenic nerve (which controls the diaphragm) by cancer or chest surgery,
• brain infection or tumor,
• severe kidney failure,
• an overactive thyroid gland,
• pneumonia (the inflammation of the lungs),
• severe general infections such as malaria,
• central nervous system conditions such as multiple sclerosis,
• anesthesia-related, for example during or after abdominal surgery,
• problems with body chemistry (metabolism) such as hyperglycemia (too much sugar in the body), and
• the side effects of certain drugs, for instance benzodiazepines, which are tranquillizers and hypnotics.

Diagnosis

If you have persistent hiccups (lasting for more than 48 hours), see your doctor and tell them how long and how frequently you have been hiccupping. Your doctor will examine you and may take blood and urine samples to work out the cause of your persistent hiccups, and may also arrange for a computerized tomography (CT scan) and magnetic resonance imaging (MRI scan) to be done.

Depending on your symptoms, your doctor may also arrange for an electrocardiogram and for liver function tests.

You might also have a fluoroscopy. This is a live X-ray, which provides a moving picture of your diaphragm, rather than one still picture (as with a normal X-ray).

Treatment

Normally hiccups do not need medical treatment and they will go away on their own. However, you may find that the following home remedies help:

• sipping cold water, or eating ice,
• drinking water out of the wrong (opposite) side of the glass,
• gargling with water or mouth wash,
• breathing into a paper bag ( never place a bag over your head ),
• holding your breath for a short period,
• biting on a lemon, or eating a piece of fresh ginger,
• pulling your knees up to your chest,
• or someone giving you a surprise to act as a mental distraction.

Some people find complementary therapy such as hypnosis and acupuncture help with hiccups, but currently there is no conclusive evidence to support this.

Medical treatment is needed only for persistent hiccups. In some cases the underlying cause can be identified and treated, in order to stop the hiccups coming back. A study of 72 people with persistent hiccups revealed that 55 of them had problems with upper gut, such acid reflux, which was then treated, thus curing the hiccups.

Medication can be prescribed by your doctor if no underlying cause is found. Tranquillizers, such as chlorpromazine and metoclopramide, work by relaxing the diaphragm muscle and the surrounding nerves. Medicines called anti-convulsants, such as phenytoin and valproic acid, can also help to stop the involuntary action of the diaphragm.