Hiccup

Page last reviewed: 13/07/2011

Hiccups occur when the diaphragm suddenly and involuntarily contracts (tightens), resulting in a hiccup sound being produced at the top of the trachea (windpipe). The medical name for hiccups is "singultus".

The diaphragm is a thin membrane of muscle that separates the chest cavity from the abdomen (tummy). It is underneath the ribcage and helps to control breathing.

Hiccups are a reflex action, which means that you do not have any control over them. Hiccups are not usually serious and in most cases they only last for a few minutes.

Persistent and intractable hiccups

In rare cases, hiccups can last for a long time. Hiccups that last for more than 48 hours can be categorised into:

  • persistent or protracted hiccups - a bout of hiccups that lasts for more than 48 hours
  • intractable hiccups - a bout of hiccups that lasts longer than a month

How common are hiccups?

Hiccups are common and most people will get them at some point during their life. They can affect people of any age, including babies. Men and women are equally affected by episodes of short-lived hiccups.

However, for reasons that are unclear, persistent and intractable hiccups are more common in men. Intractable hiccups are more common in adults. These types of hiccups can be very tiring and upsetting, and they can make eating and drinking difficult.

It is important to remember that persistent and intractable hiccups are very rare and are usually caused by another underlying health condition. In 80% of cases of persistent or intractable hiccups, a cause can be identified. The remaining 20% of cases usually have a psychological cause.

Outlook

Most hiccups will pass quickly and usually only last for a few minutes. Treatment is not usually required.

However, in cases of persistent or intractable hiccups that last longer than 48 hours, further investigations are needed to identify the cause and appropriate treatment.

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Page last reviewed: 13/07/2011

Hiccups occur when your diaphragm (the thin layer of muscle that separates your chest cavity from your abdomen) suddenly and involuntarily contracts (tightens).

As your diaphragm contracts, it causes you to breathe in air very quickly. The incoming air is stopped when your glottis (the opening between your vocal cords) closes suddenly, producing the characteristic sound of a hiccup.

Short-term hiccups

Most cases of hiccups occur for no apparent reason. Everyone experiences a short bout of hiccups from time to time. This is perfectly normal and nothing to be concerned about.

The most common causes of short-term hiccups are:

  • consuming large amounts of alcohol
  • excessive smoking
  • a bloated stomach - usually as a result of eating or drinking too quickly
  • a sudden change in room temperature
  • a sudden change in the temperature inside your stomach

Sometimes, short-term hiccups may also occur as a result of:

  • shock
  • stress - the feeling of being under pressure
  • excitement

See below for more information about psychological factors that can cause hiccups.

People experiencing short-term hiccups usually get better without the need for treatment.

Persistent and intractable hiccups

In rare cases, persistent and intractable hiccups can be caused by a more serious underlying condition, such as gastro-oesophageal reflux disease (GORD) (see below). However, in other cases the cause of hiccups remains unknown (idiopathic).

Several conditions can cause hiccups. However, even with testing and investigation an underlying cause can sometimes not be identified.

Possible underlying conditions

Some of the conditions that can potentially cause long-term hiccups include:

  • gastro-oesophageal reflux disease (GORD) - a condition where stomach acid flows back into the oesophagus (gullet)
  • gastroenteritis - a stomach and bowel infection that causes repeated diarrhoea (loose, watery stools)
  • small bowel obstruction
  • gastritis - inflammation of the stomach
  • pharyngitis - a sore throat that is usually caused by a viral or bacterial infection
  • laryngitis - inflammation of the voice box (larynx)
  • goitre - swelling of the thyroid gland
  • hypoglycaemia - low levels of sugar (glucose) in the blood
  • diabetes - a long-term condition caused by too much sugar (glucose) in the blood

Medication

Persistent hiccups can sometimes be caused by a reaction to certain types of  medication. For example:

  • anaesthesia - medication that is given before a surgical operation or procedure that causes a loss of sensation 
  • corticosteroids - medication that reduces inflammation (swelling)
  • benzodiazepines - a type of sedative that helps to reduce anxiety
  • barbiturates - a type of sedative that are sometimes used to prevent seizures (fits)
  • opioids - medication that is used to treat pain; morphine and methadone are both strong opioids
  • methyldopa - medication that is used to treat high blood pressure (hypertension)

Psychological factors

Persistent hiccups are sometimes associated with psychological factors. For example, they may occur as a reaction to a strong feeling or emotion such as:

  • shock
  • fear
  • grief
  • excitement
  • hysterical behaviour
  • anxiety 
  • stress 

Possible complications

Prolonged hiccups can sometimes cause a number of complications. For example, in some cases it can lead to:

  • insomnia 
  • weight loss, due to difficulty eating
  • exhaustion
  • depression 

Visit your GP or another healthcare professional if you have hiccups that have lasted longer than 48 hours and you are unsure about what is causing them.

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Page last reviewed: 13/07/2011

Hiccups that last for less than 48 hours and stop on their own do not require a diagnosis from your GP.

Visit your GP if you have had hiccups that have lasted for longer than 48 hours. They will look at your medical history and may carry out a physical examination to try to establish the cause.

Physical examination

The aim of the physical examination is to try to find out what is causing your hiccups, such as identifying any underlying condition that may be contributing to the problem. Areas of your body that your GP may want to examine include the:

  • head and neck (including your mouth)
  • chest
  • abdomen (tummy)

Tests

If your GP suspects that your hiccups have an underlying cause, you may need to have a series of tests. There are several that your GP may want to carry out depending on the specific underlying condition that they want to confirm or rule out. The tests may include:

  • blood tests - to check for conditions such as diabetes, infections, kidney disease and hypoglycaemia (low blood sugar levels)
  • electrocardiogram(ECG) - a test that measures the electrical activity in your heart and is used to check for heart-related conditions
  • urine testing - used to rule out certain infectious diseases
  • chest radiography - a detailed type of X-ray that can be used to check for signs of a chest infection or possible tumours
  • computerised tomography (CT) scan - this type of scan can be used to check for conditions that affect the head and abdomen (tummy)
  • magnetic resonance imaging (MRI) - this type of scan can be used to check for conditions that affect the nervous system, such as multiple sclerosis  

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Page last reviewed: 13/07/2011

Most cases of hiccups do not require medical treatment and will usually stop after a short period of time.

Self-care

However, there are a number of things that you can try which may help to stop your hiccups. These include:

  • slowly sipping ice-cold water
  • holding your breath for a short period
  • gently placing pressure on your nose while swallowing
  • gently placing pressure on the diaphragm
  • gargling with water
  • biting on a lemon
  • swallowing granulated sugar
  • drinking from the far side of a glass
  • tasting vinegar
  • breathing into a paper bag (never place a bag over your head)
  • holding your breath for short periods
  • pulling your knees up to your chest
  • leaning forward to compress your chest

Treating underlying conditions

If an underlying health condition is causing your hiccups, treating it will help to resolve the problem. If your hiccups are persistent, or last for longer than 48 hours (intractable), your GP will investigate whether an underlying condition may be causing them.

Some conditions that cause persistent and intractable hiccups may need to be assessed and treated by a specialist. If this is the case, your GP will refer you to the appropriate healthcare professional, who will carry out further investigations and recommend appropriate treatment.

Medication

If your hiccups last for 48 hours or more, and your GP feels it is appropriate, you may be prescribed medication. If your child has persistent or intractable hiccups, they will usually have to visit a specialist before being prescribed any form of medication.

Medication for hiccups is often only used when other forms of treatment have failed or if no underlying cause can be found.

Some medicines that you may be prescribed for the treatment of long-term hiccups include:

  • chlorpromazine
  • haloperidol
  • baclofen
  • metoclopramide
  • gabapentin

Your GP will usually prescribe a two-week course of medicine for you and they may gradually increase the dosage until your hiccups are brought under control. The length of time that you will need to take the medicine for will depend on your individual circumstances, including:

  • your age
  • your general health
  • the severity of your hiccups

All medicines can cause side effects. Therefore, before taking any, seek advice from your GP or pharmacist about any potential side effects you may experience.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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