Hiccups!

Is an involuntary tightening of the diaphragm in the abdomen forcing your vocal cords to close and resulting in the “hic” sound we are all familiar with. For the most part hiccups resolve on their own. If hiccups last more than 48 hours they are called persistent hiccups. If they last longer than a month they are called intractable hiccups, and may present as painful, frequent, and can interrupt breathing, cause GERD, irregular heartbeat, fatigue, difficulty sleeping, and weight loss due to difficulty eating. It may present as a tightening feeling in your chest, abdomen, or throat. Men are affected more than women.

Causes of hiccups include coughing, swallowing too much air, eating fast, smoking, drinking something really hot and then really cold, abdominal hernia, GERD, fast eating, intense emotions, carbonated drinks, dry rice or bread, alcohol, or laughing. Other causes include irritation of the medulla in the brain from kidney failure, stroke, multiple sclerosis, meningitis, cancer, infections, mental health problems, or damage to the vagus nerve after having surgery. From the brain to neck vertebrae C3 and C5 there is a nerve called the phrenic nerve. It is also called the hiccup center. This area allows a person to breathe out or exhale. If this area is irritated in any way the diaphragm may spasm and pulls air into the lungs, closing the wind pipe or trachea, which results in the “hic” sound.

Treatment is usually not necessary as it often resolves on its own. However, for chronic hiccups, the first treatment is the cause. For example, if the cause is GERD, omeprazole may be prescribed to treat the GERD. There is no specific treatment otherwise. Medications used in the past have been Gabapentin, Proton Pump Inhibitors, Reglan, chlorpromazine, and baclofen. Sometimes the phrenic nerve can be blocked temporarily with Procaine 0.5%, or removal of the phrenic nerve can be performed. Lidocaine gel 2% in the ear canal can trigger a reaction from the vagus nerve that may help stop the hiccups. Anti-psychotics, muscle relaxants, and sedatives have provided some help, as well as rectal massage. Home care remedies include swallowing crushed ice or dry bread to stimulate the gag reflex and thereby stimulating the vagus nerve. Holding one’s breath or breathing through a paper bag may help. Drinking something cold fast, eating a teaspoon of sugar, honey, or peanut butter are other home remedies that have been tried.

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