ALL YOU NEED TO KNOW ABOUT HICCUPS: CAUSES, PREVENTION AND TREATMENT

Hiccups are an amusing and often annoying reflex that appear spontaneously when we least expect them. In an effort to quell these sudden spasms, people have tried everything from holding their breaths to tricking their way out through distraction. A few home remedies may be effective solely on the principle of belief, with some advocating vinegar or peanut butter to get rid of hiccups.

It is important to note that persistent hiccups may indicate a serious health condition for which one ought to seek medical attention. The following article explores the causes and triggers of hiccups, how remedies work best for prevention, and when to get medical help for intractable hiccups.

Why do Hiccups Happen?

Remedies for hiccups only make sense when one understands why hiccups happen.

Hiccups constitute an involuntary reflex that occurs due to repeated contractions of the intercostal muscles (lining the rib cage) and those of the diaphragm. The spasms are thought to be triggered by irritation or activation of the phrenic nerve, which connects the brainstem to the diaphragm and to nearby structures such as the heart and throat.

During a hiccup, the glottis contracts and abruptly closes the airways, which causes one to inadvertently swallow air and gives rise to the iconic ‘hic’ sound. While hiccups can be frustrating, the other alternative is hyperventilating, which would happen if the glottis did not contract.

As the phrenic nerve is connected to both the vagus nerve and the “hiccup center” in the brainstem, excessive activation of either can induce hiccups. The vagus nerve extends to several other organs and tissues and could be a trigger for some of the strangest causes of hiccups. These include reports of hiccups induced in men by stroking or shaving their beards or from a hair tickling the eardrum.^[1]

Common hiccup triggers include:

• Stomach distention or over-fullness
• Digestive issues
• Heart problems
• Temperature changes
• Laughter
• Stress or strong emotions

The Reason for Hiccups

Unlike other reflexes with understandable objectives, such as coughing or sneezing, the reason we hiccup continues to be a mystery. Currently, the strongest argument for why we hiccup is to release excess air from the stomach and lower esophagus.^[2] Thus, the reflex may occur due to eating or drinking too fast, too much, or after swallowing too much air. This might also explain why hiccups often end in burping, yet not why it is exclusive to all mammals or why hiccupping occurs in utero.

How Long Do Hiccups Last?

Most cases of hiccups usually last only a few minutes and tend to resolve within 48 hours. They average roughly 4-60 cycles of spasms per minute and may come and go during this time. In the worst case, this could mean having to endure one hiccup per second for several minutes at a time until they subside.

Persistent Hiccups

If hiccups last longer than 48 hours, they are considered to be chronic or persistent hiccups and might be a sign of a more serious underlying medical condition. These can be especially problematic, capable of interfering with one’s sleep, breathing, and ability to perform ordinary activities such as eating or drinking. They can also cause exhaustion, dehydration, weight loss, and depression due to disrupted sleep and eating patterns.

Common causes of persistent hiccups include:

• Digestive disorders, such as GERD
• Brainstem or nerve damage
• Stroke or heart attack
• Infections
• Tumors
• Allergies
• Heart problems
• Respiratory conditions
• Medications such as cisplatin and dexamethasone

For hiccups that last more than 48 hours or that cause severe symptoms, you should seek out a doctor’s appointment as soon as possible.

While some cases of intractable hiccups are caused by worrisome health concerns, others are not. Charles Osborne reportedly held the world record for the longest attack of hiccups for 68 years, according to Guinness World Records. Despite finding no cause or cure for his condition, he still managed to lead a full life, living to the age of 97 after marrying twice and fathering 8 children.

Can hiccups Cause Heart Problems?

Hiccups are not known to directly cause heart problems, although some patients with heart conditions are known to present with persistent hiccups as a leading complaint. Some studies suggest that the irregular breathing induced by hiccups may increase the risk for heart arrhythmias if the heart beats in sync^[3]. The risk may be greater in those with pre-existing heart conditions, COPD, or hypertension.

Hiccup Prevention: Can Hiccups Be Avoided?

Without an underlying health condition, hiccups can be prevented by minimizing well-known triggers and being more mindful while eating and drinking.

To prevent hiccups, try to minimize the following:

• Eating or drinking too fast
• Frequent intake of carbonated drinks or spicy foods
• Overeating
• Stress

Quick Fixes and Remedies to Make Hiccups Stop

Even with the best precautions, a fit of hiccups might still catch you by surprise for something as simple as a hair in your ear.

All of the remedies for curing hiccups involve three approaches: raising blood CO2, stimulating the vagus nerve, or distracting from the reflex. Most of them are not scientifically proven, yet they may work depending on the cause of hiccups and your degree of sensitivity. Classic remedies are reviewed below.

Raising Blood CO2 with Breathing Techniques

One way to stop hiccups is by increasing the level of CO2 in the blood. If blood CO2 can be raised enough, it interrupts hiccupping by forcing the body to need more oxygen. This effectively triggers a survival instinct that overrides the annoying spasms.^[4] One can try to do away with hiccups by holding their breath, although this may only work if you can hold your breath for longer than a minute and may be a stressful remedy.

There are a few easier methods for upping your CO2 that you might prefer to try, such as:

Breathing Into a Paper Bag. This has proven effective at getting rid of hiccups in studies. Breathing into the bag works by recycling the CO2 you would otherwise exhale. It can take anywhere between 1.5-4 minutes to work. Take care not to hyperventilate!

Diaphragmatic Breathing. A type of deep breathing technique called diaphragmatic breathing, also known as belly breathing, increases blood CO2 while relaxing the diaphragm muscles. For diaphragmatic breathing, inhale slowly and deeply via your nose to fill your lungs with air, followed by an exhalation through your mouth to completely empty them. Try to hold your breath in between for as long as possible. Repeat this for a few minutes until the hiccups stop.

Stacked Inhalation. This refers to a technique of stacking inhalations and may be the fastest way to get rid of hiccups. After taking a breath, hold it for 10 seconds. Without exhaling, take another deep breath and hold it for a couple of seconds before taking in a third one. This quickly concentrates CO2 and immobilizes the diaphragm.

Stimulating the Vagus Nerve

Another way to stop hiccups is to stimulate the vagus nerve. This can cause the body to shift from hiccupping to a different reflex, such as swallowing. The vagus nerve connects to many muscles and organs, including the diaphragm and throat, and can also help to calm hiccup spasms.

Common techniques that stimulate the vagus nerve include:

Drinking Water or Eating. Slowly swallowing or chewing gets the muscles of the esophagus to work, which stimulates the vagus nerve and interrupts the reflex. This is also the reason why some remedies consist of eating honey or peanut butter slowly, as these may cause the throat muscles to work harder at swallowing. Eating or drinking may also alleviate the cause of hiccups by getting rid of any trapped air in the stomach.

Gargling with Cold Water. Make some noise while you do it. This can activate your vagus nerve by shocking it with a cold sensation, working the vocal cords, and using muscles to swallow.

Massaging the Diaphragm. Try to massage your diaphragm by applying gentle pressure beneath your rib cage. This can give different signals to the area that is spasming and relax the vagus nerve. Curling up in a ball might make this technique more effective by compressing the abdomen.

Other techniques to try include:

• Grabbing and pulling on your tongue
• Gently pressing your eyes while shut
• Plugging your ears or pulling on your ear lobes
• Sipping on a cup of hot water or herbal tea

Tricking the Reflexes with Distraction

Some people advocate using forms of trickery to get rid of hiccups. It works by diverting your attention away from them while stimulating other nerves or muscles that can interfere with the reflex. Distraction also explains why some bizarre remedies might work, such as giving people a fright, telling them a shocking story, or offering an instant reward if the hiccups stop.

Drinking from the wrong side of the glass is one of the most common distraction techniques used. Tilt your head forward and drink from the far side of the glass. Aside from being a bit mentally bewildering, this can make you swallow more air and stretches the diaphragm.

Other distraction techniques include biting a lemon wedge or letting salt or sugar dissolve on the tongue. These cause mildly intense sensations that can help to distract from the hiccups.

Hiccup Treatment Options

In the absence of a known cause, such as a tumor, a doctor may prescribe medications to treat persistent hiccups. These work by changing or inhibiting the nerve transmission involved in the reflex and by calming the diaphragm. Examples include^[5]:

• Chlorpromazine is the most commonly used drug and is the only one approved by the FDA for combating hiccups. It can help reduce the severity of hiccups by blocking dopamine receptors in the brain.
• Metoclopramide is another example that shows promise for patients with hiccups. The way it helps with nausea and gastric motility can also affect the hiccup reflex and improve symptoms.

Muscle relaxants, calcium channel blockers, antidepressants, sedatives, or stimulants have also been reported to help treat hiccups.

Surgery is a last resort for treating hiccups that do not respond to remedies or medication. The most common surgical procedure performed is a phrenic nerve block, which involves injecting an anesthetic into the phrenic nerve to stop the diaphragm from spasming. This can be a temporary or permanent fix, depending on the severity of the hiccups.

Another surgical option is vagus nerve stimulation, where a device is implanted in the patient which sends electrical impulses to the nerve and regulates its activity. This is typically used for those with epilepsy, yet may help to lessen the frequency and intensity of hiccups.^[6]

When to Seek Medical Attention

Persistent hiccups can indicate a serious health problem, such as heart disease, stroke, or cancer. Therefore, it is important to see a doctor if hiccups last longer than 48 hours or if severe enough to interfere with your daily activities. If you experience other symptoms such as abdominal pain, fever, vomiting, shortness of breath, arrhythmia, or blood in cough, schedule an appointment with your doctor right away.

Conclusion

Hiccups are involuntary reflexes that are caused by repeated contractions of the diaphragm and throat. They are usually harmless and tend to resolve within a few minutes, yet they can be annoying and uncomfortable. To prevent hiccups, it is advisable to eat and drink slowly, avoid spicy or carbonated foods and beverages, manage stress, and refrain from overeating. Some quick fixes and remedies that may work to cure hiccups include diaphragmatic breathing, drinking hot or cold water while gargling, swallowing foods or beverages, or drinking from the wrong side of the glass. These methods are not scientifically proven and may not work for everyone.

If hiccups last longer than 48 hours or interfere with your daily routine, you should seek medical help as they may indicate a serious underlying condition. Persistent or intractable hiccups can cause exhaustion, dehydration, weight loss, and depression and may require medication or surgery to treat.

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