Health Talk: Hiccups

Chugging cold water, swallowing straight honey, holding your breath — when it comes to hiccups, desperate times call for desperate measures. Though hiccups are generally thought of as comical, harmless afflictions, cases can vary dramatically in severity and duration.

Hiccups occur in patients of all races and health conditions, though they are slightly more common in males than females. Younger people get the hiccups more often than older ones — unborn babies even hiccup in the womb.

Hiccups are caused by a spasm contracting the diaphragm, a muscle essential in human respiration. The diaphragm is a sheet of muscle between the body’s chest cavity and the abdominal cavity. Under normal circumstances, the diaphragm contracts to enlarge the chest cavity, drawing air into the lungs like a vacuum. When the muscle relaxes, air is pushed out of the lungs and the body exhales.

However, when the diaphragm contracts in a spasm, the body begins to inhale but is interrupted by an abrupt closing of the glottis, the space between the vocal cords. This sudden closure causes the classic “hic” sound that gives hiccups their name. A spasm in the diaphragm can be caused by something as common as a full stomach, the result of eating too quickly, drinking excessive amounts of alcohol, or swallowing air.

Hiccups brought on by a full stomach are usually mild and can go away without any treatment within several minutes or hours. Yet, some cases of hiccups are significantly more enduring. Doctors call hiccups that last beyond 48 hours persistent hiccups, and hiccups that last for a month or more are called intractable hiccups.

Intractable hiccups are rare and reflect more severe symptoms, like weight loss and exhaustion. Both persistent and intractable hiccups are usually indicators of other health problems, often more serious than a full stomach. These underlying issues range from mental health problems to metabolic disorders to nerve irritation in the head, neck, and chest. Additionally, problems in the central nervous system, including cancer, stroke, injury, and infection, can lead to hiccups.

Though most mild cases of hiccups will stop on their own, there are plenty of home remedies available for impatient sufferers. Tricks like pulling your tongue, biting a lemon, or drinking from the far side of the glass are good for stopping hiccups within the first few minutes. These methods target the nasopharynx, a piece of the pharynx that connects to the nasal passage.

Some other hiccup remedies work by disrupting the respiratory cycle; these include holding your breath, drinking cold water quickly, or even getting scared. When home remedies like these are unable to quell hiccups, mild treatments like acupuncture and hypnosis can often do the trick.

Still, more severe cases may require the help of a medical professional, whose methods can include massaging the back of the neck or the carotid sinus artery (also in the neck), or even pressing on the eyeball; indirectly, these methods affect nerves in the diaphragm. Similarly, doctors may recommend diaphragm-relaxing medication for patients suffering from persistent or intractable hiccups. For especially stubborn hiccups, doctors may pursue more drastic treatments, such as a surgical procedure to isolate the nerves of the diaphragm.

Alternatively, doctors can target the pharynx by inserting a tube in the nose or mouth, in addition to draining the stomach by using a tube in the nose. Some doctors even recommend a rectal massage, a seemingly backwards way of relaxing the nerves around the glottis.

Though there are a seemingly endless amount of home and medicinal treatments for hiccups, some especially elusive cases can go on for years or even decades. The longest-lasting case of hiccups was Charles Osborne, a man from Iowa who hiccupped for 68 years straight. Now an entry in the Guinness World Records, Osborne did not let his constant hiccupping hold him back; he appeared on numerous television programs, including The Tonight Show, and even married twice.

Whether they last for minutes or months, hiccups remain an elusive and comical nuisance to practically everyone. Next time your glottis closes and releases a telltale “hic,” just hope it does not last for another 68 years.