By Peter J. Rice, PharmD, PhD, BCPS, FAPhA
I had the occasion to read up on hiccups today, and found them just too interesting not to pass along some information. We’ve all had hiccups at one time of another, and wonder where they come from, what they do, and often how to get rid of them.
The medical term for a hiccup (or hiccough) is a ‘singletus’, with a Wikipedia definition of an ‘involuntary contraction of the diaphragm’ which ends a fraction of a second afterwards with closure of the glottis at the back of the throat. Hiccups are not considered life-threatening, but can cause anxiety, depression or flat-out exhaustion if they go on for too long and disturb eating or sleep.
Hiccups are assumed to represent a primitive physiological function that at one time had some survival benefit, but no one really knows what good might have come from hiccups. They are thought to result from misfiring of either the phrenic nerve (involved in breathing) or the vagus nerve, which is involved in digestion and many other body functions.
Hiccups are classified as benign, persistent or intractable depending on their duration. Benign hiccups last from a few minutes to two days. They’re considered to be persistent if they remain up to one month, and intractable if they last longer than that. Intractable hiccups are considered to have more than 100 different causes including structural, metabolic, inflammatory and infection. The most common cause of hiccups, and one that I can identify with, is overeating; when your stomach is full, you are more likely to have the hiccups. Some medicines are associate with hiccups, so check with your pharmacist if needed.
How to Get Rid of Hiccups
Just as there are many causes for hiccups, there are also many interventions that have been proposed as treatments. The problem is that there are no large randomized studies to help choose the best cure for hiccups. Also, with so many potential causes for hiccups it is likely that there might be different cures for different causes. Instead, human experience provides numerous anecdotal stories of what seemed to work in some patient at some time. My mom always mentioned scaring the person with hiccups; the current psychiatric term for this would be ‘distraction’. I found trying to swallow a dry substance that cannot be swallowed to work well. But there are also respiratory approaches like holding your breath or breathing into a bag, or stimulating the nose and throat through various drinking, eating or gargling maneuvers. Gastrointestinal approaches center around emptying the stomach through fasting, pumping or vomiting. There are various maneuvers to stimulate the vagus nerve as well; holding your breath and briefly bearing down (called the Valsalva maneuver) might be worth a try.
Every now and then I dispense a prescription for a patient with ‘intractable’ hiccups, most recently one of our students at University of Colorado Boulder. I always try to talk with my hiccup patient, and usually find that while the textbook definition of intractable is longer than a month, patients consider their hiccups intractable after a much shorter duration, often a day or two.
Medications for hiccups are aimed at major triggers and various steps in the nerve loop responsible for hiccups. Initial therapy might be aimed at decreasing stomach distension with simethicone (for burping) or metoclopramide, a drug which encourages food to move out of the stomach into the intestines. Other drugs, including antidepressants and anticonvulsants target nerve pathways. The drug Chlorpromazine is the only medication approved by the Food and Drug Administration for treatment of persistent and intractable hiccups.
Next time you hiccup, think of the nerve pathways that must be involved and ask your friends for advice on their favorite strategy to stop hiccups. I hope whatever you decide to try will work for you. But if not, remember that your community pharmacist is always available to talk about treatment options and to advise you on next steps to take.
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