UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of hiccups

Author
Anthony J Lembo, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

Hiccups are a common and usually transient condition affecting almost all people in their lifetime. Rarely, hiccups become intractable and can lead to adverse outcomes.

This topic will discuss the pathophysiology, etiology, evaluation, and treatment of hiccups.

DEFINITIONS

A hiccup is an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles. Muscle contraction results in a sudden inspiration and ends with abrupt closure of the glottis, thereby generating the characteristic 'hic' sound. Hiccups often occur with a frequency of 4 to 60 per minute, remaining relatively constant in a given individual.

The medical term for hiccups (also referred to as "hiccoughs") is singultus, derived from the Latin singult, which means "a gasp" or "a sob." Hiccups can be divided into three categories based upon their duration [1]:

A "hiccup bout" is an episode of hiccups lasting up to 48 hours

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon May 02 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Kolodzik PW, Eilers MA. Hiccups (singultus): review and approach to management. Ann Emerg Med 1991; 20:565.
  2. Souadjian JV, Cain JC. Intractable hiccup. Etiologic factors in 220 cases. Postgrad Med 1968; 43:72.
  3. Cabane J, Desmet V, Derenne JP, et al. [Chronic hiccups]. Rev Med Interne 1992; 13:454.
  4. Calsina-Berna A, García-Gómez G, González-Barboteo J, Porta-Sales J. Treatment of chronic hiccups in cancer patients: a systematic review. J Palliat Med 2012; 15:1142.
  5. Smith HS, Busracamwongs A. Management of hiccups in the palliative care population. Am J Hosp Palliat Care 2003; 20:149.
  6. SAMUELS L. Hiccup; a ten year review of anatomy, etiology, and treatment. Can Med Assoc J 1952; 67:315.
  7. Kobayashi Z, Tsuchiya K, Uchihara T, et al. Intractable hiccup caused by medulla oblongata lesions: a study of an autopsy patient with possible neuromyelitis optica. J Neurol Sci 2009; 285:241.
  8. Kahrilas PJ, Shi G. Why do we hiccup? Gut 1997; 41:712.
  9. Lewis JH. Hiccups: causes and cures. J Clin Gastroenterol 1985; 7:539.
  10. Fass R, Higa L, Kodner A, Mayer EA. Stimulus and site specific induction of hiccups in the oesophagus of normal subjects. Gut 1997; 41:590.
  11. Witter F, Dipietro J, Costigan K, Nelson P. The relationship between hiccups and heart rate in the fetus. J Matern Fetal Neonatal Med 2007; 20:289.
  12. Park MH, Kim BJ, Koh SB, et al. Lesional location of lateral medullary infarction presenting hiccups (singultus). J Neurol Neurosurg Psychiatry 2005; 76:95.
  13. Nagayama T, Kaji M, Hirano H, et al. Intractable hiccups as a presenting symptom of cerebellar hemangioblastoma. Case report. J Neurosurg 2004; 100:1107.
  14. Payne BR, Tiel RL, Payne MS, Fisch B. Vagus nerve stimulation for chronic intractable hiccups. Case report. J Neurosurg 2005; 102:935.
  15. Renes SH, van Geffen GJ, Rettig HC, et al. Ultrasound-guided continuous phrenic nerve block for persistent hiccups. Reg Anesth Pain Med 2010; 35:455.
  16. Pooran N, Lee D, Sideridis K. Protracted hiccups due to severe erosive esophagitis: a case series. J Clin Gastroenterol 2006; 40:183.
  17. Albrecht H, Stellbrink HJ. Hiccups in people with AIDS. J Acquir Immune Defic Syndr 1994; 7:735.
  18. Yamazaki Y, Sugiura T, Kurokawa K. Sinister hiccups. Lancet 2008; 371:1550.
  19. Hassen GW, Singh MM, Kalantari H, et al. Persistent hiccups as a rare presenting symptom of pulmonary embolism. West J Emerg Med 2012; 13:479.
  20. Doshi H, Vaidyalingam R, Buchan K. Atrial pacing wires: an uncommon cause of postoperative hiccups. Br J Hosp Med (Lond) 2008; 69:534.
  21. Krysiak W, Szabowski S, Stepień M, et al. Hiccups as a myocardial ischemia symptom. Pol Arch Med Wewn 2008; 118:148.
  22. Ng JL, Aziz EF, Herzog E. Electrocardiogram for hiccups? Am J Med 2011; 124:e5.
  23. Krahn A, Penner SB. Use of baclofen for intractable hiccups in uremia. Am J Med 1994; 96:391.
  24. George J, Thomas K, Jeyaseelan L, et al. Hyponatraemia and hiccups. Natl Med J India 1996; 9:107.
  25. Hansen BJ, Rosenberg J. Persistent postoperative hiccups: a review. Acta Anaesthesiol Scand 1993; 37:643.
  26. Van Damme PA. Post operative hiccups. Int J Oral Maxillofac Surg 2008; 37:1071.
  27. Theohar C, McKegney FP. Hiccups of psychogenic origin: a case report and review of the literature. Compr Psychiatry 1970; 11:377.
  28. Rousseau P. Hiccups. South Med J 1995; 88:175.
  29. Shay SS, Myers RL, Johnson LF. Hiccups associated with reflux esophagitis. Gastroenterology 1984; 87:204.
  30. Marsot-Dupuch K, Bousson V, Cabane J, Tubiana JM. Intractable hiccups: the role of cerebral MR in cases without systemic cause. AJNR Am J Neuroradiol 1995; 16:2093.
  31. Marinella MA. Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol 2009; 7:122.
  32. Friedman NL. Hiccups: a treatment review. Pharmacotherapy 1996; 16:986.
  33. Viera AJ, Sullivan SA. Remedies for prolonged hiccups. Am Fam Physician 2001; 63:1684, 1686.
  34. Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013; :CD008768.
  35. Petroianu GA. Treatment of hiccup by vagal maneuvers. J Hist Neurosci 2015; 24:123.
  36. Howard RS. Persistent hiccups. BMJ 1992; 305:1237.
  37. FRIEDGOOD CE, RIPSTEIN CB. Chlorpromazine (thorazine) in the treatment of intractable hiccups. J Am Med Assoc 1955; 157:309.
  38. Madanagopolan N. Metoclopramide in hiccup. Curr Med Res Opin 1975; 3:371.
  39. Pinczower GR. Stop those hiccups! Anesth Analg 2007; 104:224.
  40. Wang T, Wang D. Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study. Intern Med J 2014; 44:1205.
  41. www.fda.gov/medwAtch/safety/2009/safety09.htm#Metoclopramide (Accessed on October 17, 2011).
  42. Ramírez FC, Graham DY. Treatment of intractable hiccup with baclofen: results of a double-blind randomized, controlled, cross-over study. Am J Gastroenterol 1992; 87:1789.
  43. Guelaud C, Similowski T, Bizec JL, et al. Baclofen therapy for chronic hiccup. Eur Respir J 1995; 8:235.
  44. Kang JH, Bruera E. Hiccups during Chemotherapy: What Should We Do? J Palliat Med 2015; 18:572.
  45. Kang JH, Hui D, Kim MJ, et al. Corticosteroid rotation to alleviate dexamethasone-induced hiccup: a case series at a single institution. J Pain Symptom Manage 2012; 43:625.
  46. Lee GW, Oh SY, Kang MH, et al. Treatment of dexamethasone-induced hiccup in chemotherapy patients by methylprednisolone rotation. Oncologist 2013; 18:1229.
  47. Hernández JL, Pajarón M, García-Regata O, et al. Gabapentin for intractable hiccup. Am J Med 2004; 117:279.
  48. Gilson I, Busalacchi M. Marijuana for intractable hiccups. Lancet 1998; 351:267.
  49. Bilotta F, Rosa G. Nefopam for severe hiccups. N Engl J Med 2000; 343:1973.
  50. Askenasy JJ, Boiangiu M, Davidovitch S. Persistent hiccup cured by amantadine. N Engl J Med 1988; 318:711.
  51. Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage 2009; 38:460.
  52. Alderfer BS, Arciniegas DB. Treatment of intractable hiccups with olanzapine following recent severe traumatic brain injury. J Neuropsychiatry Clin Neurosci 2006; 18:551.
  53. Neuhaus T, Ko YD, Stier S. Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer 2012; 20:3009.
  54. Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and baclofen for the treatment of intractable hiccups. Pharmacotherapy 2014; 34:e4.
  55. Matsuki Y, Mizogami M, Shigemi K. A case of intractable hiccups successfully treated with pregabalin. Pain Physician 2014; 17:E241.
  56. Lin YC. Acupuncture for persistent hiccups in a heart and lung transplant recipient. J Heart Lung Transplant 2006; 25:126.
  57. Ge AX, Ryan ME, Giaccone G, et al. Acupuncture treatment for persistent hiccups in patients with cancer. J Altern Complement Med 2010; 16:811.
  58. Chang CC, Chang YC, Chang ST, et al. Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors. Scand J Gastroenterol 2008; 43:538.
  59. Schiff E, River Y, Oliven A, Odeh M. Acupuncture therapy for persistent hiccups. Am J Med Sci 2002; 323:166.
  60. Smedley WP, Barnes WT. Postoperative use of hypnosis on a cardiovascular service. Termination of persistent hiccups in a patient with an aortorenal graft. JAMA 1966; 197:371.
  61. BENDERSKY G, BAREN M. Hypnosis in the termination of hiccups unresponsive to conventional treatment. Arch Intern Med 1959; 104:417.
  62. Dobelle WH. Use of breathing pacemakers to suppress intractable hiccups of up to thirteen years duration. ASAIO J 1999; 45:524.
  63. Schulz-Stübner S, Kehl F. Treatment of persistent hiccups with transcutaneous phrenic and vagal nerve stimulation. Intensive Care Med 2011; 37:1048.
  64. Longatti P, Basaldella L, Moro M, et al. Refractory central supratentorial hiccup partially relieved with vagus nerve stimulation. J Neurol Neurosurg Psychiatry 2010; 81:821.
  65. Byun SH, Jeon YH. Treatment of idiopathic persistent hiccups with positive pressure ventilation -a case report-. Korean J Pain 2012; 25:105.