Anyone can get a case of the hiccups: adults, kids, babies – even fetuses, as they practice breathing in utero. Hiccups can make us giggle or grumble, but we all sigh with relief when they finally stop. You can hiccup from four to 60 times a minute, with men tending to hiccup more frequently and for longer periods.
Cases that last more than two days are called “persistent,” and those that last more than a month “intractable.” One Iowa resident, Charles Osborne, set the world record for the intractable hiccups: After a fall resulting from a mild stroke, he hiccupped for a remarkable 68 years straight until he suddenly and mysteriously stopped in 1990, a year before his death. It is estimated that during that span, he hiccupped 430 million times.
Courtesy of Harvard Health Publishing, Harvard Medical School
The medical term for hiccups is singultus, from the Latin “singult,” the word for catching one’s breath while sobbing. Hiccups occur when a person’s diaphragm suddenly spasms between breaths, causing them to suck in air. The vocal cords snap shut, attempting to stop the sudden intake of air, thus producing the “hic” sound.
So what causes hiccups? Anything that stretches the stomach or diaphragm can trigger a bout of hiccups by irritating either the phrenic nerve, which powers the diaphragm, or the vagus nerve, which regulates breathing. Carbonated beverages, overeating, drinking or eating too fast, and chewing gum can all bring on hiccups. Overstretching the neck, which pulls on the phrenic nerve, can trigger them as well.
Hiccups can also be caused by things that are irritating to the stomach, like alcohol, spicy foods, nicotine, steroids and chemotherapy. Anything that lowers the level of carbon dioxide in the blood – such as hyperventilation from anxiety or overexcitement – can also be a trigger. Lung irritants like inhaled anesthetics may result in hiccups as well.
Everyone knows at least a few home remedies for getting rid of hiccups. And while many may sound a bit bizarre, they’re safe and often do the trick! Some include swallowing a spoonful of sugar, drinking water upside down from a sippy cup, eating a dollop of peanut butter or pieces of dry bread, gargling with ice water, chewing on a lemon slice, or having someone scare you by jumping out and yelling “boo!” (Needless to say, don’t try all of these at once.)
You may also short-circuit hiccups by stimulating the vagus nerve. This can be done in a variety of ways: by plunging your face into a sink full of cold water (a recommended cure since the 16th century), gently pressing on closed eyelids with your fingers, or pulling on the tip of your tongue. Energizing the phrenic nerve with gentle neck stretches can also be effective. Just turn your head left and right, up and down, then roll it in a circular motion, repeating 10 times.
One of the most effective medical treatments for hiccups is the supramaximal inspiration technique, which can stop diaphragm spasms and raise your blood carbon dioxide level. Exhale completely, emptying your lungs of air, then inhale deeply and hold for 10 seconds. Then, without exhaling, inhale two more times and hold your breath for five more seconds. Release and repeat. Another recommended maneuver is to sit on the floor and lean forward while holding your knees to your chest for at least a minute. Breathing into a paper bag can also stop hiccups by raising levels of carbon dioxide in your blood.
While hiccups can be embarrassing or irritating, most cases are easily solved. Only one in 100,000 cases are intractable and require a medical evaluation. Among those, 80% are due to acid reflux and will respond to antacids. In cases where no cause can be found, doctors have had some success with treatments like low-dose oral chlorpromazine (Thorazine), phrenic nerve blocks (similar to Novocain shots) or a type of Trans Electrical Nerve Stimulation (TENS) unit that mildly stimulates the vagus nerve with electricity.
There are 4,000 annual hospitalizations in the United States for intractable hiccups caused by underlying diseases such as cancer or tumors, strokes, or liver or pancreatic disorders. Treatment of the specific condition will cure the hiccups.
Still curious? You can read more about hiccups here!
Mary Jenkins is recently retired after nearly 40 years as a family practice physician in New York state.