Hiccups (Singultus) – Hiccups, Persistent Hiccups, and What Helps Relieve Hiccups

Medically, hiccups are referred to as singultus (Latin for “sobbing” or “gasping”).

Hiccups are caused by involuntary contractions of the diaphragm and the glottis. The diaphragm is the muscular partition between the chest and the abdomen. The glottis is an opening between the vocal cords that controls the flow of air into the lungs.

During hiccups, the diaphragm repeatedly performs involuntary inhalation movements, followed by a rapid and noisy closure of the glottis.

Due to the sudden closure of the glottis, inhalation is interrupted. As a result, air can no longer flow in unimpeded. This produces the characteristic inhalation sounds of hiccups, the “hiccups.”

There are two types of hiccups: acute and chronic.

Acute hiccups occur suddenly. Although they are annoying, they are usually harmless. They typically stop on their own after a short time, usually within a few minutes.

Chronic hiccups last longer than two days or recur frequently. They can significantly impair a person’s quality of life. Therefore, they always require a medical examination and treatment.

The glottis is located in the larynx between the vocal cords and can be closed or open © bilderzwerg | AdobeStock

Hiccups can have various causes. They are usually caused by temporary irritation of the phrenic nerve (nervus phrenicus). Such irritation can be triggered, among other things, by

• consuming food or beverages that are too cold or too hot,
• eating spicy food,
• eating meals that are too large,
• eating or drinking too quickly,
• alcohol consumption,
• air swallowed into the stomach,
• severe nervousness, or
• stress

.

Also,

• gastrointestinal disorders (e.g., reflux disease),
• inflammation in the chest and abdomen (e.g., pneumonia),
• cancers of the digestive or respiratory organs,
• abdominal surgery,
• a brain tumor, or
• a stroke

can, in rare cases, irritate the phrenic nerve.

In addition, hiccups often occur when the carbon dioxide concentration in the blood decreases, for example due to hyperventilation. Sometimes, no cause for hiccups can be identified at all.

When you have hiccups, your body behaves for a fraction of a second as if it were taking a breath. The sudden contraction of the diaphragm expands the chest cavity and draws air into the lungs in a jerky motion.

During this sudden inhalation of air, the glottis closes involuntarily, interrupting the inhalation. As a result, the inhaled air can no longer flow in unimpeded. It collides with the closed glottis, producing the “hiccup” sound characteristic of hiccups. This happens several times in succession.

Hiccups usually begin suddenly and stop on their own after a few seconds or minutes. This is considered harmless acute hiccups that do not require a medical examination or treatment.

Hiccups that last for a long time or occur repeatedly should be examined by a doctor, who can determine the exact cause.

The diagnosis begins with a medical history interview. During this, the doctor first asks the patient detailed questions to determine whether harmless factors are causing the hiccups. Common questions include, for example,

• when and in what situation the hiccups first occurred,
• how long they have been lasting, and
• whether they have stopped at any point in the meantime.

If this interview rules out harmless causes of the hiccups, further tests are necessary. These include, in particular, imaging procedures such as

• gastroscopy,
• an ultrasound examination,
• an X-ray of the digestive organs or lungs,
• an electrocardiogram (ECG) of the heart,
• a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the heart, as well as
• a blood test.

How hiccups are treated depends on how long they last and what causes them. Acute hiccups can usually be easily treated—or at least shortened—using a number of well-known tricks and home remedies. These include, in particular, measures such as:

• holding your breath for up to 60 seconds
• breathing into a paper bag
• leaning forward while sitting or pulling your knees up
• drinking a cold liquid
• swallowing a piece of dry bread
• Distract yourself or let yourself be distracted
• Circle your arms

Most of these home remedies aim to calm your breathing and diaphragm and increase the carbon dioxide levels in your blood. While the effectiveness of these measures hasn’t been medically proven, they’re definitely worth a try.

If the hiccups do not go away on their own or keep coming back, you should see a doctor.

Particularly persistent, agonizing hiccups can be treated, for example, with antispasmodic or sedative medications.

If the hiccups are caused by underlying conditions such as inflammation or tumors, the chronic hiccups will subside once those conditions are successfully treated.

In very rare cases, surgical treatment—such as a block of the phrenic nerve—may be used.

What causes hiccups?

Hiccups are usually caused by irritation of the diaphragm or the phrenic nerve or vagus nerve. Hiccups result from involuntary contractions of the diaphragm and a sudden closure of the glottis. Common triggers include eating too quickly, air in the stomach, gastroesophageal reflux disease (GERD), or a sudden change in temperature when drinking.

When is it considered chronic hiccups?

Hiccups are considered chronic if they last longer than two days or more than 48 hours. Chronic hiccups may be caused by an underlying condition such as a stroke, inflammation, or a disorder of the respiratory muscles. Idiopathic chronic hiccups are diagnosed when no clear cause can be identified despite diagnostic testing.

What helps with hiccups?

Simple home remedies often help relieve hiccups, such as consciously holding your breath, drinking slowly, or increasing the carbon dioxide concentration in the blood. When experiencing hiccups, consciously controlling your breathing can help interrupt the reflex. In severe cases, various medications such as baclofen or proton pump inhibitors may be considered for treating hiccups.

Is hiccups normal in babies?

Hiccups in babies are common and usually harmless. Hiccups can even occur in the womb as the diaphragm develops. Hiccups while drinking are often caused by air in the stomach and are generally not a sign of illness.

When should you see a doctor for hiccups?

If hiccups persist for a long time, if severe additional symptoms such as dizziness, visual disturbances, or signs of paralysis occur, or if the hiccups are very distressing, you should seek medical evaluation. In rare cases, persistent hiccups may be caused by a serious underlying condition. In such cases, specific diagnostic testing—including a CT scan if necessary—is required.