What Causes Hiccups? How To Get Rid Of Hiccups?

A hiccup is a sudden, involuntary contraction of the diaphragm, followed about 35 milliseconds later by the glottis snapping shut, which makes the “hic” sound. They are usually triggered by eating or drinking too fast, fizzy drinks, alcohol or a sudden change in temperature, and almost always pass within minutes. See a doctor if hiccups last more than 48 hours.

While there can be many underlying medical conditions or factors that lead to hiccups, they are most commonly caused by eating or drinking too quickly, which can leave the stomach distended and irritated. That irritation sets off a reflex that makes the diaphragm contract, and the hiccups begin.

Imagine you’re standing in front of your class, about to launch into a presentation, when a strange sound emerges from your throat, accompanied by a slight jerk of your shoulders and head. You hope desperately that it won’t happen again, but that isn’t likely. There’s a good chance you have the hiccups, and it could be a while before you’re ready to speak without interrupting yourself every 15 seconds.

There is no doubt that many of you have experienced a poorly timed hiccup attack at some point in your life, but the real question is – why do we get the hiccups in the first place?

Hiccups

By definition, a hiccup begins with a sudden, involuntary contraction of the diaphragm, the dome of muscle beneath the lungs that normally does the heavy lifting of breathing. The intercostal muscles between the ribs join in, and together they yank a quick burst of air into the lungs. So far, this looks just like the start of a normal breath, except that you didn’t ask for it and you can’t stop it. Doctors call the condition singultus, and a hiccup attack usually runs at a steady rhythm of anywhere from 4 to 60 hiccups per minute.

Here’s the twist that turns an ordinary breath into that unmistakable “hic”. About 35 milliseconds after the diaphragm jerks down, the glottis (the gap between your vocal cords) snaps shut, slamming the door on the air that was rushing in. That abrupt cut-off is what makes the sound, and the same jolt of muscle activity is what produces the little shudders or jerks of the shoulders, neck and head. The whole sequence is a reflex: sensory signals travel up the vagus and phrenic nerves to the brainstem, which fires motor signals back down the phrenic nerve to the diaphragm and the vagus nerve to the voice box. As a result, no amount of willpower will make a hiccup stop on cue.

What Causes Hiccups?

In most cases, hiccups are caused by the stomach becoming distended, which is common if you eat or drink something too quickly. When the stomach swells, it presses on the diaphragm and can push stomach acid back up into the esophagus, irritating nerves that share the hiccup reflex pathway. That irritation triggers the diaphragm to contract, and the hiccups begin. This is why a big meal, fizzy drinks, alcohol or a sudden change in temperature are such reliable culprits. The good news is that most cases of the hiccups are little more than annoyances, and rarely last more than a few minutes.

However, hiccups can be caused by other things as well, particularly if they last for long periods of time, sometimes even days or weeks of chronic hiccuping. Doctors put a clock on it: a bout under 48 hours is called acute (this is the everyday kind), anything lasting longer than 48 hours is persistent, and a spell that drags on for more than a month is intractable. If your hiccups last for more than two days, it may be time to go and see a doctor. These extended bouts are usually a sign of an underlying problem that should be addressed. Damage to or irritation of the phrenic or vagus nerve, which feed the hiccup reflex, is often to blame, but acid reflux, certain metabolic disorders (such as low sodium or kidney trouble) and central nervous system conditions can all keep the reflex firing. People who have had a stroke, a brain tumor or a recent surgery may also be at increased risk of long bouts of hiccuping.

Just how stubborn can hiccups get? Consider Charles Osborne, an Iowa farmer who, according to Guinness World Records, started hiccuping in 1922 after a fall while slaughtering a hog and did not stop until 1990, a 68-year run estimated at around 430 million hiccups. His doctors believed the fall had damaged a tiny patch of his brainstem, the very region that normally keeps the hiccup reflex in check. Thankfully, cases like his are extraordinarily rare.

For most people, hiccups are occasional annoyances, and can even be amusing, but for chronic sufferers of hiccups, it can cause anxiety, depression and insomnia… have you ever tried falling asleep with hiccups? It’s not easy!

The list and details of other neurological, metabolic and physiological causes of hiccups is outside the scope of this article, but if you regularly suffer from short bursts of hiccups and want to prevent these temporary occurrences, there are some things you can avoid.

How To Get Rid Of Hiccups

If you have an excess of gas in the stomach, there is a good chance you will experience hiccups, so try to eat slower, or eat less food. When you swallow, you are also adding air to your stomach, which can fill up your gut. When you drink soda or beer, it will speed up the rate at which you get hiccups, so drink slowly, allowing your stomach to process the food at a reasonable pace.

Eating hot or spicy foods can often irritate the phrenic nerve and cause hiccups, so be sure your food is at a normal temperature before taking a bite. Sudden changes in temperature can also cause hiccups, but there isn’t much you can do about the weather!

Finally, some medications may increase your risk of hiccups, including corticosteroids, painkillers, barbiturates and benzodiazepines, but be sure to speak with your doctor before making any changes to your medication. If one of your medications is causing chronic hiccups that last for hours or days at a time, there might be alternative options.

How To Treat Hiccups

There are dozens of old wives’ tales about ways to stop hiccups naturally, including staring at a light, holding your breath, breathing into a paper bag, sipping ice water, biting on a lemon and gargling with cold water.

The honest answer is that almost none of these have been put through rigorous clinical trials, so think of them as low-risk things to try rather than guaranteed cures. That said, there is a sensible logic behind the better ones. They tend to work in one of two ways: by raising the level of carbon dioxide in your blood, or by stimulating the vagus nerve and resetting the reflex. Holding your breath is the simplest example, since it lets carbon dioxide build up, and a 2018 study found it was the rising CO₂, not the lack of oxygen, that did the trick. Swallowing a teaspoon of sugar, sipping ice water or gently pulling on your tongue work the other lever, nudging the vagus nerve. Breathing in and out of a paper bag follows the same CO₂ idea, but go easy: never use a plastic bag, stop the moment you feel light-headed, and skip it altogether if you have any heart or lung condition.

What if a bout simply will not quit? When hiccups push past 48 hours, no home trick is going to cut it, and that is a cue to see a doctor, who will look for an underlying cause and can reach for actual medication. Chlorpromazine, an older antipsychotic, is the only drug the US Food and Drug Administration has approved specifically for intractable hiccups, though doctors today often try the muscle relaxant baclofen or the nerve-calming drug gabapentin first, since they tend to be better tolerated. Metoclopramide is another option, especially when acid reflux is part of the picture. These are prescription routes, not something to attempt on your own.

No matter what you do, hiccups are something that will strike at some time when you least expect it, just like a sneezing fit, and many times, you simply have to ride it out and wait for the irritation to pass!