Hiccups Causes, Cures and Prevention

Hiccups are often annoying and embarrassing for the sufferer - and amusing to observers! Short bouts of hiccups are usually harmless. However, an extended period of hiccuping or frequent hiccuping episodes may be a sign of a serious medical condition.

There are many different causes for hiccups, including lifestyle factors, such as eating or drinking too much, certain diseases and disorders, and problems which irritate the nerves controlling the diaphragm. The diaphragm is the main muscle of inhalation. Sometimes the cause of a person’s hiccups is never discovered.

Even though hiccuping is a very common occurrence, scientists don’t completely understand what is happening inside the body to produce the hiccups. They know that the diaphragm undergoes spasms during a hiccup attack and that the vocal cords are involved in producing the hiccup sound, but they think that the brain also plays a role in hiccup production.

Hiccups occur in animals and in the human fetus. They are common in newborn babies, but the number of hiccuping episodes gradually decreases over the first few months of a baby’s life.

The diaphragm is a sheet-like muscle that lies under the lungs and has a dome-shape when it is relaxed. When the diaphragm contracts during inhalation, it moves downwards and causes the lungs to expand. The air molecules left in the lungs after the last exhalation then spread out to fill the extra space. This reduces the air pressure in the lungs. Since air is now at a higher pressure outside the body than inside the lungs, air moves into the lungs through the nose and mouth.

The trachea, or windpipe, is the tube that transports inhaled air to the lungs. At the start of the trachea is an expanded region called the larynx, or voice box. The larynx contains the two vocal cords (also known as vocal folds), which are positioned across the diameter of the air passage. When we are not producing sound the vocal cords are separated by a v-shaped space. This space allows air to pass into and out of the trachea. When we need to make sounds, the vocal cords move closer together. A complex combination of vocal cord vibrations and muscle actions then produces our speech.

A hiccup results when the diaphragm undergoes a series of spasms (sudden, involuntary contractions). The spasms occur at a rate of about 4 to 60 times a minute, but most fall in the range of 15 to 30 times a minute. During each spasm of the diaphragm air moves rapidly into the airway and the vocal cords slam together. The inflow of air is stopped and the characteristic hiccup sound is produced.

There are a huge number of factors that can cause a hiccup attack. Eating too much, which produces a large amount of stomach expansion, or eating too quickly can both trigger hiccups, and so can swallowing air while eating. An overfilled or bloated stomach can interfere with the normal action of the diaphragm, since the stomach is located underneath this muscle. Irritation of the diaphragm can cause hiccups. Eating very spicy food, drinking carbonated drinks or an excessive amount of alcohol are also common causes of hiccups. In addition, heartburn, or acid reflux (movement of stomach acid up into the esophagus) can produce a bout of hiccups, and so can stomach ulcers. Chewing gum causes hiccups in some people. A sudden temperature change in the stomach or in the room can trigger hiccuping. Intestinal problems, such as duodenal ulcers and inflammatory bowel disease, have also been linked to hiccups. Kidney problems can cause hiccups too.

Hiccups may be triggered by any process that irritates the phrenic nerve, which travels from the spinal cord in the neck to the diaphragm, or the vagus nerve, which travels from the brain to the diaphragm and to other parts of the body. These processes include a swelling in the neck, such as a goiter, cyst or tumor. Hiccuping may be caused by a disorder in the throat or chest cavity such as a sore throat or a respiratory disease such as pneumonia, asthma or bronchitis. Some types of surgery can cause hiccups in patients.

Problems in the brain such as a stroke, meningitis, encephalitis, multiple sclerosis or a tumor can also cause hiccups. Metabolic problems such as hypoglycemia and hyperglycemia and certain medications have produced hiccup attacks, and so have emotional stress and excessive smoking. Even heart problems have been linked to hiccups.

Generally, a "hiccup bout" is an episode of hiccups that last for a few seconds to forty eight hours. After hiccuping for forty eight hours a person should seek medical attention. If hiccups last for several days or weeks, they are known as "persistent hiccups." If hiccups last for more than a month they are said to be "intractable." The longest known episode of hiccups lasted for sixty eight years! Charles Osborne from Iowa hiccuped from 1922 until 1990. 

Even if hiccups are not linked to any serious disease, long-term hiccups may lead to sleep disturbances and can be exhausting. A severe and chronic hiccuping problem can also cause malnutrition, dehydration and weight loss. Acid reflux, aspiration pneumonia and heart irregularities have arisen in some people with severe, untreated hiccups.

Several home remedies have been found to stop hiccups in some cases. These methods rely on increasing the carbon dioxide level in the blood or on stimulating the vagus nerve. For example, holding your breath or breathing into a paper bag raises the carbon dioxide level in the blood. Firmly pulling the tongue stimulates the vagus nerve. A teaspoon of sugar placed on the back of the tongue, drinking ice-cold water, biting a lemon or drinking vinegar stimulates the back of the throat and ends some hiccup bouts. Even drinking from the far side of a glass has been reported to cure hiccups.

Leaning forward to compress the chest or raising the knees to the chest ends hiccups in some people. If a person suffering from hiccups is startled or if they are mentally distracted, the hiccups may stop. 

Acupuncture has helped some people with hiccups that won’t go away. There have also been reports of people cured of their hiccups after hypnosis.

Doctors have several ways to treat severe hiccups. Relieving any underlying health condition that may be responsible for the hiccups is important. There are several medications that are very effective in eliminating hiccups. Anticonvulsant drugs have been helpful for some people. Local anesthetics have sometimes helped people who haven't responded to medications.

To reduce the chance of a hiccup attack, don’t overfill your stomach, avoid very spicy food, restrict alcohol consumption and don't smoke. Avoid any personal triggers, such as drinking carbonated beverages, eating or drinking too fast or chewing gum. If you have persistent, unexplained ailments that might be responsible for hiccups, try to find a diagnosis and a treatment.

For the vast majority of people hiccups are an inconvenience but not a permanent problem. Even without a home treatment the hiccup attack will disappear on its own. If someone is experiencing severe or prolonged hiccup episodes, doctors today have a range of treatment options which can bring relief.