The mysterious hiccupJust about everybody hiccups, at least now and then. Even fetuses and animals hiccup. Usually it’s a nuisance, an embarrassment, but little more. It lasts for a few moments, rarely longer than an hour or two, and then disappears because of, or despite, efforts to stop it. Common triggers include alcohol, carbonated beverages, spicy foods, eating too fast, and sudden and severe emotional stress.
For reasons that are not understood, those stimuli sometimes activate the vagus nerve, behind the throat, which in turn sends a message to the diaphragm, causing it to contract and the chest to expand. That triggers a rapid influx of air through the nose and mouth. In less than 35 milliseconds the glottis (a tissue flap that guards the entrance to the trachea, or windpipe) closes and produces the characteristic sound as the incoming air is blocked from entering the trachea.
Hit or miss solutionsEveryone has a pet remedy for hiccups, though most probably have no idea why they try what they do. But there may actually be some rationale for certain common techniques. For example, holding your breath, breathing into a paper bag, or sipping a glass of water slowly and without breathing all increase carbon-dioxide levels in the blood, which may decrease the sensitivity of the vagal nerve center in the brain. And stuffing a finger into each ear, drinking ice water, stroking the back of the throat with a swab, or swallowing a teaspoon of table sugar may also depress vagal nerve activity.
When hiccups last longer than a day or so, medical intervention can usually end the suffering. And, as with any disorder that has no specific cure, there are many treatments that are usually tried. Chlorpromazine (Thorazine and generic), a major tranquilizer, is the old standby, closely followed by the minor tranquilizer diazepam (Valium and generic), the antispasmodic metochlopramide (Reglan and generic), and the muscle relaxant baclofen (Lioresal and generic). If one doesn’t work, the next one might. Occasionally, the topical anesthetic lidocaine can be sprayed on the back of the throat. When those measures fail, passing a tube through the nose into the stomach often works.More than inconvenient
The longest recorded case of unexplained hiccups lasted 63 years. But hiccups that linger beyond a few days are often a worrisome sign. They can be traced to problems anywhere from the belly to the brain. Causes include benign and malignant tumors, inflammation, infections, and neurological disorders. While hiccups are often the only obvious symptom, a careful medical history and follow-up with appropriate imaging tests can usually reveal the cause.On further questioning I learned that our college student had had an appendectomy about a month before the hiccups started, with the seemingly uneventful removal of an inflamed appendix. But she had never quite recovered and in the past two weeks had experienced night sweats and possibly a low-grade fever. A CT scan of her abdomen showed a collection of fluid under her right diaphragm that turned out to be an abscess, no doubt a result of leakage from the removed but infected appendix. Following drainage of the abscess and a prolonged course of antibiotics, her hiccups gradually diminished and eventually disappeared. She is now a very healthy professor—who still reacts with fear and trepidation to any recurrence of hiccups, no matter how short-lived.
—Marvin Lipman, M.D., Consumer Reports chief medical adviser