Hiccups: causes and remedies

Hiccups are an involuntary contraction of the diaphragm, the muscle that separates the chest area from the abdomen and plays an important role in breathing.
Each contraction is accompanied by a sudden closing of the vocal cords, which then cause the characteristic “hick” tone.
Hiccups are a reflex behavior and therefore cannot be controlled.

The diaphragm is innervated by the phrenic nerve. If this nerve becomes irritated, hiccups may occur.

Hiccups can also be caused by some other areas of the central nervous system:

• The nerve center that controls breathing (the diaphragm is the main muscle for inhalation).
• The hypothalamus is a structure of the central nervous system that controls many bodily functions.

Often the hiccups are rhythmic. It is usually a temporary disorder, but prolonged hiccups may indicate that you have a serious condition.
The longest hiccups ever recorded lasted sixty years. Men and women can have hiccups with the same frequency, however, hiccups lasting longer than 48 hours are much more common in men.

Hiccups can also occur in a fetus that is still in the womb.

Who suffers from hiccups?
Hiccups are very common. It affects men and women equally.
Hiccups occur mainly in the evening.
In women, it is more common before the cycle and occurs less frequently during pregnancy.

Causes of temporary hiccups

In most cases, there is no discernible reason, it lasts a little and then passes again.

Sometimes it arises due to:

• Sudden arousal.
• After eating too much, too quickly or after drinking carbonated drinks.
• Aerophagia or swallowing air.
• Poor digestion, which can lead to the formation of air in the abdomen. In this case, you have the feeling of having to burp during hiccups.
• A sudden change in temperature in the stomach digesting very hot foods, from drinking ice-cold drinks, during a cold shower, etc.
• Drinking large amounts of alcohol (drunkenness).
• Smoking in excess.
• Stress, feeling under pressure.

Causes of permanent hiccups

In rare cases, permanent hiccups may be caused by a more serious condition such as gastroesophageal reflux.
In other cases, the cause of hiccups often remains unknown (idiopathic).
Various diseases can cause hiccups.
But even through investigations and tests, it is not always possible to find out an underlying cause.

Possible concomitant diseases
Some diseases that can cause long-lasting hiccups include:

• Gastrointestinal diseases – such as gastroesophageal reflux and ulcers.
• Respiratory diseases, such as asthma, pneumonia or pleurisy.
• Diseases that affect the central nervous system – such as stroke, brain tumor, encephalitis or craniocerebral trauma.
• A disease that irritates the vagus nerve (which could interfere with nerve signals) such as goiter, pharyngitis, or meningitis.
• A psychological reaction, for example: fear, pain, agitation, anxiety or stress.
• Renal failure.
• Pericarditis – this is an inflammation of the outside of the heart. This can irritate the phrenicus, which innervates the diaphragm. The result is hiccups.
• Diseases that affect metabolism (the body’s way of digesting food), for example, diabetes, hypocalcemia and hyponatremia.

Medication
Persistent hiccups can be caused by the reaction to certain types of medications.
For example:

• Anesthetics – a drug that is administered before surgery or procedure and leads to loss of sensitivity.
• Corticosteroids – medications that reduce inflammation (swelling).
• Benzodiazepines – a type of sedative, including diazepam (Valium), alprazolam (Xanax) and lorazepam (Tavor).
• Barbiturates – a type of sedative used to prevent spasms.
• opioids – drugs used to treat pain; Morphine and methadone are two powerful opioids.
• Methyldopa – drugs used to treat high blood pressure (hypertension).

Surgical interventions
Abdominal surgery can irritate the nerve that excites the diaphragm, which then leads to hiccups.

Hiccups in newborns

Causes that can trigger hiccups in newborns include:

1. Insufficient development of the gastrointestinal tract
2. A disorder of the cardia (valve between stomach and esophagus)
3. Sudden change in outside temperature (for example, when changing diapers)
4. Swallowing air while eating
5. Belch

Possible complications of hiccups

Persistent hiccups can sometimes cause various complications.
For example, in certain cases, it can cause:

1. Insomnia
2. Weight loss due to difficulty eating
3. Exhaustion
4. Depression

Diagnosis of hiccups

A hiccup that lasts less than 48 hours and then passes spontaneously does not require an introduction to the family doctor.
However, one should consult a doctor if the hiccups persist for more than 48 hours.

Test
If the family doctor suspects that the hiccups are caused by another medical condition, they may perform some investigations, such as:

1. Blood test to rule out kidney and liver disease or diabetes.
2. An X-ray or magnetic resonance imaging to rule out anatomical malformations or a space requirement that presses on the phrenicus, vagus or diaphragm.
3. An electrocardiogram (ECG) (an examination that measures the electrical activity of the heart) to check for the presence of heart disease.
4. An endoscopy, if the hiccups are suspected to be caused by gastroesophageal reflux.

Home remedies for hiccups

It is believed that the home remedies used can stop hiccups according to two principles. One way to treat hiccups is to block the vagus nerve by another stimulus.
The vagus nerve signals the brain to take care of other things, so the hiccups must stop.
Other home remedies act on breathing by provoking a greater amount of carbon dioxide in the blood.
This induces the body to deal with the excess carbon dioxide instead of causing hiccups.

Some natural remedies for hiccups

Mitigate
hiccups One trick may be to cause a sweet sensation at the nerve endings in the mouth. If possible, put a teaspoon of sugar on the back of the tongue, in the area where “sour” tastes.
In this way, the overload of sugar is a stronger trigger.
Normally, the hiccups go back quickly if you suck a teaspoonful of sugar with a splash of lemon on it.
Unfortunately, sugar and lemon are not always available.

Stimulus through the ears

Some doctors advise sticking a finger in your ears to interrupt hiccups.
The nerve plexus of the vagus nerve also reaches the hearing system.
By irritating the nervous endings of the ears, the vagus nerve comes into action.
You have to be careful and not put your fingers too deep into your ears.

Be frightened
If someone startles a person with hiccups, the vagus nerve can be stimulated in such
a way that the hiccups are interrupted.

Drink
water Swallowing water can interrupt the cycle of hiccups and calm nerves.
Gargling can have the same effect.

Pull
on the tongue Stick your tongue out of your mouth and pull it outwards. This can interrupt the hiccups.

Tickle
Tickle the soft palate with a cotton ball to solve the problem.

Hold
your breath Squeeze nostrils with two fingers and close your mouth.
The method is the same as when diving in a swimming pool.
Hold your breath as long as possible until you notice that the hiccups are over.

Hiccups in a bag
It is believed that breathing back into a paper bag works in the same way as holding your breath.
In both, the amount of carbon dioxide in the blood is increased and the body forgets about the hiccups, because it has to take care of a much bigger problem.

Remedy for hiccups in infants

Hiccups in young children pass after a few minutes, as in adults, but there are some remedies that are more likely to solve the problem.
For example, you can give the child a teaspoon of water or put it on the breast again for another feeding.
Another option is to provoke a sneeze by placing a finger on the nose to stretch the diaphragm.

How is permanent hiccups treated?

First, the common means for treating short hiccups are tested, as explained above.
In addition, the cause must be treated, if it is known.
Secondly, medication is sometimes required to prevent permanent hiccups.
Various medications can be used for this.
The following medications may be useful to treat adults with a hiccup. For children, a specialist examination is recommended.

Medications that the doctor may prescribe include:

1. Chlorpromazine (Largactil ®) and haloperidol are medications that can relax the diaphragmatic muscles and thus end a permanent hiccup.
2. For stomach problems such as acid reflux, there are: antacids (for example, omeprazole or ranitidine).
3. Medications to prevent nausea and vomiting (for example, Paspertin®).
4. Baclofen – this drug is used for muscle relaxation.
5. Gabapentin – this can help reduce diaphragmatic nerve symptoms
6. Administering a medication called metoclopramide for vomiting may be an intravenous beneficial treatment for hiccups.
7. For people in the final stages of an illness, sedatives such as midazolam can be helpful in treating hiccups and relieving the stress it causes.

Surgical intervention and injections

If the hiccups persist, the surgeon may recommend injecting an anesthetic to block the phrenic nerve and stop the hiccups.

Another option is the surgical implantation of a battery-powered device that sends a weak electrical impulse to the vagus nerve. This procedure is used for epilepsy, but it can also reduce permanent hiccups.

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