Dr. Decipher: Hiccups - Causes and Cures

By Dr. John Janousek, M.D. Monday, March 01, 2010

Hiccups are involuntary contractions of the diaphragm, followed by closure of the glottis (vocal cord folds). They are annoying, but episodes usually only last a few minutes. Such was not the case for Charles Osborn, an Iowa hog farmer, listed in the Guinness World records for having hiccups for 68 years, from 1922-90.

Interestingly, Mr. Osborne led a fairly normal life, married, had 8 children, appeared on the Tonight Show and in Dear Abby, then his hiccups spontaneously ended after approximately 480 million times in 1990.

Cheyenne Motland from Washington State hiccupped for 5 weeks in 2007 (diagnosed with Tourette’s syndrome).

What causes hiccups?  Baily in 1943 proposed the hiccup reflex which involves the nervous system, specifically the phrenic and vagal nerves. The phrenic nerve innervates the diaphragm. No specific purpose to hiccups has been described; I believe it is one of the body’s responses to choking on a foreign body.

There are numerous true medical conditions that can cause intractable hiccups and these need to be investigated in severe and prolonged cases. Basically, it is any condition that can affect the vagus and phrenic nerves, diaphragm, or the central nervous system. Hiccups are a well-known unusual presentation of myocardial infarction. Numerous neoplasms (tumors), infections and electrolyte abnormalities (calcium, potassium, sodium) can cause hiccups. One fairly common cause is gastro-esophageal reflux.

Most remedies involve affecting some part of the hiccup reflex. We all have our home remedies: holding breath, eating peanut butter, drinking water from the far side of the glass, swallowing sugar from a spoon, biting a lemon and scare tactics (distraction). I read about a teen-age girl who wanted to help her mother who had the hiccups, so she told her she was pregnant. The scare worked!

In medical texts, some vagal nerve stimulation maneuvers have been described as useful, including: iced gastric lavage, valsalva maneuver (holding one’s breath and bearing down), and get this, digital rectal massage (sir, I know hiccups is your problem, but please bend over and pull down your pants!). In the Emergency Department we give Thorazine as the drug of choice.

Drinking alcohol or carbonated beverages and prolonged laughter are associated with hiccups. (Hey, they go together). Christian Strauss, a researcher in Calgary suggests that hiccups are an evolutionary reflex from amphibians. Frogs gulp air and water in a similar reflex.

Well, I’m not sure about humans being frog-like, but I am looking for good remedies for hiccups. Any ideas?