What is the treatment for hiccups?
Short bouts of hiccups
Most cases need no treatment, as a bout of hiccups usually soon goes.
There are many popular remedies that are said to stop a short bout of hiccups but they are based on people's individual experiences. It is not clear how effective they are, as they have not been tested by research trials. They include the following:
- First, block off all airways by putting fingers in your ears and blocking your nostrils. Then, take a sip or two of water from a glass. It is possible to do this alone (looks a bit silly - but is possible) but you may find it easier with an assistant.
- Sipping iced water.
- Swallowing granulated sugar.
- Biting on a lemon or tasting vinegar.
- Breath holding, breathing fast, or breathing into a paper bag.
- Gasping after a sudden fright, or sneezing.
- Pulling your knees up to your chest and/or leaning forward to compress the chest.
- Using a technique called the Valsalva manoeuvre. (The Valsalva manoeuvre means trying to push your breath out while you hold your throat and voice box closed.) The way to do this is to take a deep breath in, then keep the air inside you while pushing with your muscles as if to force the air out. This is like pushing in childbirth or straining on the toilet.
What is the treatment for persistent hiccups?
If an underlying cause is found then treatment of the underlying cause, if possible, may cure the hiccups. For example, one research study found that many people with persistent hiccups had a gut condition called acid reflux. See separate leaflet called Acid Reflux and Oesophagitis for more details. Treating the reflux seemed to help stop hiccups in many cases. Firstly, try any of the popular remedies used to treat short bouts of hiccups (explained above). Also, treat any underlying cause, if possible.
Secondly, medication is sometimes needed to stop persistent hiccups. Various medicines have been used for this. The following medicines may be used for treating adults with hiccups (for children, specialist advice is recommended):
- Chlorpromazine and haloperidol are medicines which can relax the diaphragm muscle or its nerve supply and may stop persistent hiccups.
- For stomach problems such as acid reflux or a stretched (distended) stomach: anti-acid medicines (various types, such as omeprazole or ranitidine) or medicines which help the stomach to empty faster (such as metoclopramide).
- Baclofen - this is a medicine which helps to relax muscles.
- Gabapentin - this can help to relax the nerve supply to the muscle under your lungs that helps you breathe in (the diaphragm).
- Ketamine - an intravenous anaesthetic - is sometimes effective when other treatments have failed.
- Giving a medication called metoclopramide by intravenous injection has been reported to cure hiccups occurring after anaesthetic.
- For people with a terminal illness, sedatives such as midazolam can help to control hiccups and relieve the stress they cause.
Referral to a specialist is often advised for persistent hiccups, either to look for a cause, or to offer more treatment options. Some examples of treatments that have been successfully used for persistent hiccups are:
- Acupuncture or hypnotherapy.
- A device similar to a pacemaker. This is used to stimulate or pace the nerve to the diaphragm (the phrenic nerve) or to stimulate another important nerve in the neck, called the vagus nerve.
For hiccups that continue despite treatment, a phrenic nerve block is occasionally used. This involves interrupting the phrenic nerve - for example, by injecting a local anaesthetic near the nerve. However, this treatment needs to be considered carefully: it carries risks because the phrenic nerve is important in breathing.
Are there any complications of hiccups?
Short bouts of hiccups do not normally cause any problems or complications.
Persistent hiccups may cause complications such as tiredness, exhaustion or poor sleep. Also, they may cause psychological distress or embarrassment. For people who have had recent surgery to the tummy (abdomen), persistent hiccups may delay healing of the scar (wound), because hiccups move the abdominal muscles. This increases the risk of complications with the wound.
Further reading and references
Chang FY, Lu CL; Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil. 2012 Apr18(2):123-30. doi: 10.5056/jnm.2012.18.2.123. Epub 2012 Apr 9.
Seker MM, Aksoy S, Ozdemir NY, et al; Successful treatment of chronic hiccup with baclofen in cancer patients. Med Oncol. 2011 Mar 26.
Asadi-Pooya AA, Petramfar P, Taghipour M; Refractory hiccups due to phenytoin therapy. Neurol India. 2011 Jan-Feb59(1):68.
Lin LF, Huang PT; An uncommon cause of hiccups: sarcoidosis presenting solely as hiccups. J Chin Med Assoc. 2010 Dec73(12):647-50.
Marinella MA; Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009 Jul-Aug7(4):122-7, 130.
Arsanious D, Khoury S, Martinez E, et al; Ultrasound-Guided Phrenic Nerve Block for Intractable Hiccups following Placement of Esophageal Stent for Esophageal Squamous Cell Carcinoma. Pain Physician. 2016 May19(4):E653-6.
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