I have actually had rather few doctors in my life, but I have had enough to know that they are not all created equally. I have had more in the alternative world but some in the traditional medical field as well (not to mention the complimentary specialists). Some of these physicians have spoken in ‘plain’ English and have been very helpful, and willing to admit when they don’t know something. Other times it seems that the goal of their ‘communication’ (if you can call it that) is to demonstrate their superiority. Generally, the latter types are never the sort to admit uncertainty. In today’s world this is particularly silly as doctors cannot know everything about each condition, especially ones that their patients have spent hours researching on the web. The patient really should become a team-player and good communication between players is vital.
Here is an example of less-than-clear communication, which I admit did not come out of the mouth of a doctor (thankfully), but is a real description.
A spasm of the diaphragm resulting in a rapid,
involuntary inhalation that is stopped by the
sudden closure of the glottis and accompanied by sharp, distinctive sound.“Singultus” from American Heritage Dictionary, 3rd edition
Singultus is not a musical disease. From the description above, it sounds pretty scary, doesn’t it? However, it is usually not serious. Singultus is commonly known as hiccups. At one time it was spelled hiccough as it was incorrectly thought to be a small cough. Its possible function or why it exists is not fully understood. The purpose of hiccups is not clear. There are some theories but consensus is not forthcoming.
Is there agreement on what Singultus is?
Sort of agreement. Hiccups are a rhythmic contraction of the respiratory muscles (diaphragm and intercostals). At least that seems to be a point of general agreement. But even which nerve (or two) is most involved is not a shared idea. A nerve in the upper end of the spinal cord (in the neck or cervical region) stimulates the action, like a reflex. This controlling nerve is known as the phrenic nerve, which after coming out of the neck descends down on the right and left between the lung and heart to the diaphragm. The phrenic is the motor supply to the diaphragm and is vital for breathing (although it has fibers for both motor action and autonomic – ‘automatic’ – body functions). The point that this nerves comes out from the neck should not be missed as it is part of the reason so many ‘remedies’ include neck motion and breathing. (See later).
However, this phrenic nerve is not the only player. The second player is a Cranial Nerve (10th cranial nerve to be exact) called the Vagus. This is Latin for ‘wandering’ and is probably called such because it travels so far in the body – from the brain to the abdomen, with branches that affect many other organs. It too can be irritated by pressure from tight muscles or tendons, most often in the neck. It governs many reflex responses and (like the phrenic) does some automatic things in the body. It helps us speak, controls some muscle movement, keeps us breathing, aids us in digesting our food both through the stomach and intestines, regulates our heart beat and transports many necessary chemicals throughout the body. Some of you who have ever fainted may have heard the term (another in ‘doctor speak’) called vaso-vagal response. When the vagus nerve is stimulated to such a degree it can cause a sudden drop in heart-rate and blood pressure so much that we pass out. All cranial nerves are important; the vagus is no exception and is quite fascinating. When it comes to hiccups it is certainly playing a role. My guess would be that the more serve the condition, the more this nerve comes into play. (See more on this below for irretraceable hiccups).
Causes?
It is difficult to say where the cause of hiccups starts (or even if it is important). Does it start in the brain where the cranial nerve is located or where the cervical nerve is controlled, or in the neck where the nerve originates and leaves the spinal cord? Does it start in the chest where the phrenic nerve travels, or in the abdomen where the diaphragm (the control muscle) is located?
Basically I want to answer that question by asking, WHO CARES? The only ‘causes’ we want to hear about (if we are not researchers) is WHAT CAUSES CAN I CONTROL? Are there things I can do or avoid or keep hiccups at bay?
Maybe there are some things that you can do to decrease the triggers – within reason. I love carbonated drinks (especially club soda or flavored mineral waters) and I don’t get hiccups that often. I have a friend who almost constantly chews gum, and while she may be convinced to give it up for other reasons, I doubt hiccups will be on her list. And I can guarantee you that I am not giving up my drink. If you only get hiccups occasionally take the list of triggers (and their avoidance with a grain of salt).
The triggers for most people (not suffering from severe or frequent hiccups) include sudden shock, stress, excitement, over-eating, minor stomach upsets like gas and bloating, irritation from spicy food, eating too quickly, drinking too much alcohol or carbonated (fizzy) beverages, chewing gum, irritations like hairs near the eardrum, strong laugher, and reactions to sudden temperature changes. One other trigger may be pregnancy. During pregnancy women often encounter hiccups but not their own. They can feel the baby hiccup especially when the baby is pressing against the diaphragm.
Triggers for more severe or frequent hiccups are categorized as either nerve irritation (of the two nerves above), metabolic disorders and electrolyte imbalances, Central Nervous System problems (like stroke, brain injury, tumors, Multiple Sclerosis and more), surgery (particularly abdominal surgery), bacteria, liver failure, and excessive drug use (especially barbiturates, tranquilizers, steroids and alcohol). We won’t tell the insurance companies that like to raise rates for any possible risk, but men tend toward more long-term hiccups than women. If you would like to learn more from the scary perspective of hiccups check out the Mayo clinic. Generally hiccups are considered harmless but for those who have had long bouts (usually that means 48 hours plus) they can have very unpleasant and understandable side-effects including fatigue and insomnia, depression, weight loss and problems with regular communication.
Cure?
Most of us are probably more concerned with eliminating rather than understanding hiccups. Unfortunately there is no fool-proof answer for that either. Your family probably taught you some method for eliminating hiccups, such as breathing into a brown bag, holding your breath, scaring you or sucking on sugar. If your method works or you believe it does, stick to it!
Most of the suggestions we are covering are not to CURE hiccups (which is probably only a goal for irretraceable hiccups – see below). We just want to have a way to stop hiccups when they happen – and do it fast.
My Suggested Hiccup Remedies
The fun chart following this section below may give us a laugh or two (I like ‘hair on fire’) but also allows us to easily see that the answer to hiccups is not universal. If there was one proven way, we would probably all know it. Still I will share my own creation (simplified but similar to others) and another that is not mine. Both have the advantage of not calling attention to themselves in public and working rather well.
My 2nd Favorite Remedy
You may prefer this method to mine below, especially if water or a cup is not available. It is somewhat similar to another in the chart below with only a slight variation. The following is taken from Total Breathing (McGraw-Hill) by Philip Smith (p.126) – free as ebook on line.
- Inhale a short total breath, about three seconds in duration.
- Place the tongue against the roof of the mouth with mild pressure. Hold for seven seconds.
- Exhale.
- Before you inhale again, place the tongue against the roof of the mouth with mild pressure and hold for seven seconds.
- Return to step #1. After three or four complete repetitions the hiccups should disappear.
My Favorite Remedy
I am convinced that if I could stand in front of someone and talk them through my antidote, their hiccups would soon vanish. But you know what? I have heard the same kind of claims from others – so take it for what it is worth, specifically another well-meaning suggestion. I won’t give guarantees, despite my confidence. I believe I developed this, but can’t even guarantee THAT as we never can remember everything we have heard from others. Yet I have shared this with patients and lots of friends and it is my favorite remedy. It has NEVER failed me personally.
Directions for my remedy. Sit down, and do not slump. While performing deep diagrammatic breathing (which you cannot do if you slump), CONTINUALLY drink small sips of water (or any non-alcoholic drink) and swallow. This is almost a constant swallowing. Do not take the glass from your lips and breathe the whole time. Concentrate on the breathing and on swallowing small sips. Continue without interruption until you have not hiccupped for two minutes. The keys are breathing through your nose while CONTINUALLY taking the small sips. You can do this without anyone even noticing that you are doing it. [Your eyes are still open and you can see over the glass.] The result may be accomplished quickly.
An old joke 
A man goes into a drugstore and asks the pharmacist if he can give him something for the hiccups.
The pharmacist promptly reaches out and slaps the man’s face.
“What did you do that for?” the man asks.
“Well, you don’t have the hiccups anymore, do you?”
The man says, “No, but my wife out in the car still does!”
Home Hiccup Remedies you MAY or may NOT want to try
I tend to keep an open mind about ‘old wives tales.’ Often the science has simply not caught up to the practicality yet; or the remedy may sound strange but has good basis behind it. That being said, and still maintaining my open attitude, I simply could not share the entire list of hiccup ‘remedies’ that are out there. Some seem to think if they get you thinking about something else your hiccups will just go away (maybe but doubtful). Others are just down right ridiculous and you would have to wonder if someone is joking around. And aside from that, the list is never ending. So instead let’s take some ideas that have merit – and may even work for some people but that are not necessarily as good as my remedies above.
Since hiccups can be triggered from different situations or sources, it makes sense to think that some people may respond to remedies that others find useless. Here is a substantial list for consideration. If you find one that works for you – go for it.
| 1 | The Old brown bag. Breathe into a bag – slowly and fully. The idea is that you increase the carbon dioxide in your system (bad) which stimulates the body to try to help itself by ridding it in exchange for good air – thus resets normal breathing. | Works for some I guess. But you can hyperventilate. |
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| 2 | Pressure on eyes. With the eyes closed, press thumbs against the eyeballs with enough pressure to be somewhat uncomfortable. Hold this position for 30 seconds (but not more than 3 minutes) – then when ready, quickly release. | In a few people this action could reduce blood flow to retina and compromise visual health or create a dizzy weak feeling. Enough of a reason not to do it |
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| 3 | Pinch your nose and swallow 3 times. | No evidence of success, worth the short try. |
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| 4 | Similar to above, take a deep breath and begin swallowing. See if you can breathe in more but keep swallowing and inhaling until you can’t do either any further. Then exhale very slowly and totally. It is claimed this will ‘reset’ your breath within about 30 seconds. Idea taken from: http://www.cognitial.com/hiccups.shtml Another version is to do this with your mouth open.For both, it is suggested to keep gulping, particularly if you think a hiccup is about to explode. Keep it all up for 3 minutes – and then your hiccups should be resolved.Another version of the above is inhale the same and hold the same, but exhale NOT totally. Instead keep a small amount of air and go on to next inhale. Keep this going about 15 seconds and the claim is that your hiccups will be gone | Breathing and swallowing elements are both vital.Many people have difficulty ‘swallowing air.’ |
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| 5 | Burp. Swallow air until you burp. This excessive amount of air causing you to burp is meant to reset the vagus nerve. | May be hard to do, and not too nice in public. |
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| 6 | The ears have it. There are numerous suggestions that use the ears.
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Perhaps if you laugh hard enough, your hiccups may stop.#4 – In regard to drinking and breathing, but doing all that – holding a glass AND covering your ears and holding your nose is quite a feat for one person. Plus it looks pretty stupid. Please, don’t be insulted if this is the one you use. |
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| 7 | Stretching the diaphragm, to interrupt hiccups. Breathe in as much as you absolutely can (pushing air downward toward the diaphragm). Hold 30 seconds and exhale out slowly and totally. Repeat 4 times –and it is said you will be better.Another version of this is to reach for the sky. Lock your hands and put them over your head (chin up). Reach as far as you can. Once again the idea is to stretch the diaphragm. | Stretching the diaphragm is not a bad idea, but it may take longer than some other more direct approaches. |
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| 8 | Use the bartender’s trick. Put 4 drops of Bitters on a piece of lemon and suck the juice from the wedge. [Sugar can be added, and the bitters aren’t a necessity.] It is believed that the lemon taste elicits a startle reflex (similar to being scarred by someone). | I like bitters, and they are good for some things. No clue as to whether it works for a majority of people. |
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| 9 | Yikes. Speaking of being scarred by someone, an old idea is to have someone scare you.Another variation here is to have someone tickle you until you gasp and supposedly the hiccups stop from resetting the breath. | Really? Com’on. I would like to know how many times this has worked. It is difficult to plan to be scared. But I suppose once in a while someone can startle you out of hiccups. Regarding tickling – I wonder which is really more uncomfortable hiccups or tickling? |
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| 10 | Simply try to hold your breath for a minute or two. | Can make you dizzy and I find no evidence that it works for many people. People often fully breathe and then immediately hiccup again. |
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| 11 | Cup both hands and cover both your mouth and nose. Then try to breathe normally. | Chances of it working seem slim. Can make you dizzy. |
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| 12 | Breathing simulation. Take as deep breath as you can manage and hold it. At the same time plug your nose and close your mouth AND work your diaphragm in and out as if you were breathing. The claim is that your hiccups will disappear, but they suggest that you exhale and repeat if hiccups persist OR if you need more air. Glad they gave us the last part. J | As above. |
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| 13 | Food ideas. Seems like there are a lot of remedies commandeering food products.Sugar is a favorite. Take a teaspoon of brown sugar or honey and hold it in your mouth for 5 seconds before swallowing and sipping some water. Some tweak this advice by suggesting to put the sugar on the tongue where we taste sour (at the back) and that this will deliver the most impact.Another is pickle juice (or vinegar) sipping ½ teaspoon every 7-10 seconds until hiccups stop.Salt – swallow a teaspoon of salt and then several sips of water, waiting minutes before you try this again and taking the time to breathe deeply. Another suggestion regarding salt is to place ½ teaspoon on your tongue and then keep swallowing until all the taste is gone. This one does not include water (and sounds pretty awful).Finally peanut butter (or similar consistency products). Put a tablespoon of PB in your mouth for 10 seconds – then swallow but don’t chew. It is claimed that the saliva should have started the digestion of the PB. | Sugar – we don’t need more in our lives.Pickle juice is very acidic but you may enjoy it.Salt used this way could make you vomit (although this MIGHT be the goal here and could work).Peanut butter – hmmmm, tastes good but I don’t like the idea of swallowing it without chewing and that is part of the process. |
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| 14 | Hair on fire. If you don’t care much about your hair or forehead, light a match and extinguish it. Then bring it to your forehead and slide it into the hairline. | OOOOH. Ouch. |
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| 15 | Suck harder. Make it harder to drink. Some advice to put a paper towel across a cup and drink through it, or use one of the coffee stirrers that barely have a hole in them and then suck the water. The reasoning is that you must suck harder to get the fluid, forcing your body into concentrating on that job and giving up on the hiccups. | This may manage to establish balance between contractions & expansion of diaphragm. |
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| 16 | Cough – Count – Cough. Try a couple coughs to see if it will immediately eliminate hiccups. If not, count the seconds between hiccups. Just when you think you should be hiccupping again (say 4 or 5 seconds or whatever you counted), then cough hard. Repeat this until the hiccups stop. | May interrupt the hiccup pattern. |
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| 17 | Twist your body this way and that. Several suggestions are variations of moving or changing your body position (often the neck – which remember is where the phrenic nerve is located).
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Some of these positions may cause dizziness or falling.The tuck and squeeze can irritate back-pain. |
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| 18 | Drink Topsy Turvy. While laying upside down or while bending at the waist, take a large gulp of water. Hold. Stand back up. Repeat until gone. | How do you keep from spilling the water? This is another one that can cause dizziness. |
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| 19 | Drink around the object. Put something between your teeth, like a pencil, heavy straw or stirrer; at the same time drink a glass of water. Do not let the object fall out but drink as much as you can. The claim is that it won’t take the whole glass to get rid of the hiccups. | I would like to see this done! But wouldn’t want anyone to see ME doing it. I suspect it is not easy. There are several reasons why it might work, but I have no proof. |
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| 20 | Be a singer. Put your thumbs at your waste and fingers on the back opposite. Breathe in very slowly so that you can feel the rib cage expand under your fingers. Pick any scale or vowel sound,( like do-re-mi-fa-so-la-ti-do). Sing it with a gradual crescendo and decrescendo (getting louder, getting quieter). Repeat until hiccups gone. | I love music. So whether it works or not, this is fun. |
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| 21 | Your family secret | Who am I to say. |
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Intractable vs Recurrent Hiccups
Prolonged or intractable Hiccups are RARE. They are not just annoying but can be very painful. As mentioned above they can have some underlying causes that should cause further action. A blood test or other exams (even ultrasound) may unmask the cause. Additionally, there is some hope.
Drugs are used only for intractable (or very frequent, recurring) hiccupping. First, you should always TRY one of the self-remedies, as you might stumble upon the key for you – just in case you don’t like mine (offered below). Deep breathing can help relax a hiccup, and sometimes this alone will make a difference, but not always. So if you find yourself seeking medications for hiccups treatment, do a little research first on these most commonly prescribed drugs.
Thorazine (specifically chlorpromazine) is often the short-term choice; Baclofen (a muscle relaxant); and Reglan (specifically Metoclopramide) which may be used for hiccups off label (I am not certain). You may be recommended treatment from anti-seizure or anti-arrhythmic drugs or some stimulants. Additionally you may be prescribed a drug for gastrointestinal problems if there is suspicion your hiccups are generated from digestive track disorder.
Even for the worst of the worst hiccup cases there is hope. Some of the folk remedies (as listed above) ARE forms of vagal stimulation but at the very mildest level of the scale. There are now products that are implanted into the chest to offer neurological treatment by steadily stimulating the vagus nerve. Mostly they are used for epilepsy and depression, but have been tested for hiccups (the kind that last for years). I hope it goes without saying but this is NOT WITHOUT RISK AND NOT FREE OF SIDE EFFECTS. As I said this is ONLY for the worst cases, but if you want to read more on the product, check out the details at FDA site. If this manual seems like too much to read, and you don’t have time for it, then you should not consider this step at all.
