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Hiccups

A hiccup or hiccough (generally pronounced "hiccup" independent of the spelling) is an involuntary spasm of the diaphragm; typically this repeats several times a minute. The sudden rush of air into the lungs causes the glottis to close, creating the "hic" noise. A bout of hiccups generally resolves by itself, although many home remedies are in circulation to shorten the duration, and medication is occasionally necessary. By extension, the term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern. The medical term is singultus. more...

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While many cases develop spontaneously, hiccups are known to develop often in specific situations, such as eating too quickly, taking a cold drink while eating a hot meal, eating very hot or spicy food, laughing vigorously or coughing, or drinking an excess of an alcoholic beverage. Hiccups may be caused by pressure to the phrenic nerve by other anatomical structures, or rarely by tumors.

It is still unclear to scientists exactly why hiccups occur, particularly because it doesn't seem to give us any specific benefit.

Home remedies

The following are some commonly suggested home remedies. It should be noted that while numerous remedies are offered, the vast majority fall into just a few broad categories. These categories include purely psychosomatic cures centered around relaxation and distraction, cures involving swallowing and eating (with the rationale generally that this would remove irritants or reset mechanisms in the affected region), and cures involving controlled/altered breathing.

While the first two categories may prove effective for many short lived and minor cases of hiccups, those suffering from an intractable case may become desperate sorting through various ineffective home remedies. Many of the cures centered around controlled breathing (i.e. holding breath) are often ineffective. The only underlying rationale could be the displacement of an irritated nerve through prolonged diaphragmatic expansion.

However, one respiratory remedy has a fairly sound rationale underlying it. Breathing into a bag or small enclosed container (ensuring that it is completely sealed around the mouth and nose) induces a state that is termed respiratory acidosis. The effect is caused by increasing the amount of inspired carbon dioxide, which then increases the serum level of carbon dioxide. These increased levels of CO2 lower the pH in the blood, hence creating a state of acidosis. This state of acidosis produces vasodilation and depression of the central nervous system. The effect allows for increased blood flow to the affected muscles, and suppression of the aberrant nervous impulses. Inducing a state of acidemia through hyperventilation is particularly effective in curing hiccups because the diaphragm rests directly against the pulmonary vasculature that is then flowing with especially low pH blood. It should be noted that this is a potentially dangerous action and should only be done with another person present. As the serum CO2 level rises abruptly, the person will begin to feel lightheaded and within a few minutes will pass out. If done without a spotter, the person might either injure him or herself as he or she passes out, or pass out in such a way that the bag or container continues to prevent oxygen intake (see also asphyxia).

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Hiccups
From Gale Encyclopedia of Alternative Medicine, 4/6/01 by Paula Ford-Martin

Definition

Hiccups are the result of an involuntary, spasmodic contraction of the diaphragm followed by the closing of the throat.

Description

Virtually everyone experiences hiccups, but they rarely last long or require a doctor's care. Occasionally, a bout of hiccups will last longer than two days, earning it the name "persistent hiccups." Very few people will experience intractable hiccups, in which hiccups last longer than one month.

A hiccup involves the coordinated action of the diaphragm and the muscles that close off the windpipe (trachea). The diaphragm is a dome-shaped muscle separating the chest and abdomen. It is normally responsible for expanding the chest cavity for inhalation. Sensation from the diaphragm travels to the spinal cord through the phrenic nerve and the vagus nerve, which pass through the chest cavity and the neck. Within the spinal cord, nerve fibers from the brain monitor sensory information and adjust the outgoing messages that control contraction. These messages travel along the phrenic nerve.

Irritation of any of the nerves involved in this loop can cause the diaphragm to undergo involuntary contraction, or spasm, pulling air into the lungs. When this occurs, it triggers a reflex in the throat muscles. Less than a tenth of a second afterward, the trachea is closed off, making the characteristic "hic" sound.

Causes & symptoms

Hiccups can be caused by disorders of the central nervous system, by injury or irritation to the phrenic and vagus nerves, and by toxic or metabolic disorders affecting the central or peripheral nervous systems. They may be of unknown cause or may be a symptom of psychological stress. Hiccups often occur after drinking carbonated beverages or alcohol. They may also follow overeating or rapid temperature changes. Persistent or intractable hiccups may be caused by any condition that irritates or damages the relevant nerves, including:

  • overstretching of the neck
  • laryngitis
  • heartburn (gastroesophageal reflux)
  • irritation of the eardrum (which is innervated by the vagus nerve)
  • general anesthesia
  • surgery
  • bloating
  • tumor
  • infection
  • diabetes

Diagnosis

Hiccups are diagnosed by observation and by hearing the characteristic sound. Diagnosing the cause of intractable hiccups may require imaging studies, blood tests, pH monitoring in the esophagus, and other tests.

Treatment

Most cases of hiccups will disappear on their own. Home remedies, which interrupt or override the spasmodic nerve circuitry, are often effective. Such remedies include:

  • Holding one's breath for as long as possible.
  • Breathing into a paper bag.
  • Swallowing a spoonful of sugar or peanut butter.
  • Bending forward from the waist and drinking water from the wrong side of a glass.

Acupressure techniques can also be helpful in eliminating hiccups. Acupressure is a Chinese medicine treatment that involves placing pressure on different points of the body, called acupoints. It is based on the premise that good health is based on a harmony of energy flow, or qi, throughout the body. By placing pressure on acupoints, qi is balanced and harmony--and health--is restored to the patient.

To treat hiccups through acupressure, rest the heels of the palms on both cheekbones while placing hands over the eyes. Massage the temples by pulling the thumbs in towards the palm. After massaging, remove the hands from the eyes and lightly press the tip of the nose with a fingertip.

Allopathic treatment

Treating any underlying disorder will usually cure the associated hiccups. Chlorpromazine (Thorazine) relieves intractable hiccups in 80% of cases. Metoclopramide (Reglan), carbamazepam, valproic acid (Depakene), and phenobarbital are also used. As a last resort, surgery to block the phrenic nerve may be performed, although it may lead to significant impairment of respiration.

Expected results

Most cases of hiccups last no longer than several hours, with or without treatment.

Prevention

Some cases of hiccups can be avoided by drinking in moderation, avoiding very hot or very cold food, and avoiding cold showers. When carbonated beverages are drunk through a straw, more gas is delivered to the stomach than when they are sipped from a container; therefore, avoid using straws.

Key Terms

Innervate
To supply a part of the body with nerves. For example, the vagus nerve supplies nerve function to the eardrum; therefore, we say that the eardrum is innervated by the vagus nerve.
Nerve
Fibers that carry sensory information, movement stimuli, or both from the brain and spinal cord to other parts of the body and back again. Some nerves, including the vagus nerve, innervate distantly separated parts of the body.

Further Reading

For Your Information

Book

  • Hurst, J. Willis, ed. Medicine for the Practicing Physician. 4th ed. Stamford, Conn.: Appleton & Lange, 1996.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

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