What causes hiccups – and how can you get rid of them?

Although not usually dangerous, hiccups can be annoying. For most people, hiccups will last only a few minutes, but prolonged hiccups can be a symptom of an underlying problem. Before we explore what causes hiccups and how to get rid of them, let’s find out what they are. 

What are hiccups?

Hiccups, or hiccoughs, are caused by an autonomic reflex that the body can’t control. During a hiccup, your diaphragm spasms, sucking air into the lungs, and the quick inhalation causes the epiglottis to slam shut. The diaphragm is a large sheet of muscles underneath the lungs that help us to breathe, and the epiglottis is skin at the top of your windpipe that prevents the inhalation of foods or fluids during swallowing. The immediate closure of the epiglottis causes the characteristic ‘hic’ sound.

Hiccups occur when the nerves that control the muscular activity of the diaphragm are triggered, resulting in the muscle going into spasm. Precisely what causes hiccups is unknown, but certain activities make you more prone to getting them.

What causes hiccups?

The most common triggers for short-term hiccoughs include:

• Excessive alcohol intake
• Drinking carbonated beverages
• Excitement or emotional stress
• A sudden change in temperature
• Overeating, especially hot or spicy foods
• Eating too quickly
• Cigarette smoking
• Swallowing air when chewing on gum or sucking a lolly
• Bad odours
• Pregnancy

What are hiccups a sign of?

For some people who experience hiccups, there is sometimes no apparent trigger. For a minority of people, hiccups that last longer than 24-48 hours may be a symptom of an underlying disorder, which may be placed into the following categories:

Nerve damage or irritation

Damage to the vagus or phrenic nerves can interfere with the functioning of the diaphragm and can make a person more prone to hiccups. Factors that may cause this include thyroid abnormalities such as a goitre, cyst or tumour, reflux, inflammation of the oesophagus, sore throat, laryngitis or something in your ear touching your eardrum, such as a hair.

Metabolic disorders, drugs and surgery

Hiccups can occur in people with diabetes, people who have an excessive alcohol intake and those with kidney disease or electrolyte imbalances. Certain medications, including nicotine gum, barbiturates, steroids, and anaesthesia, and abdominal or chest surgery can cause hiccups as a side-effect.

Infection and inflammation

Pleurisy (inflammation of the membrane surrounding the lungs) and pneumonia (inflammation of the lungs) can interfere with the function of the surrounding nerves and muscles, which can lead to hiccups.

Central nervous system disorders

An infection, damage or tumour in the central nervous system can disrupt the body’s normal control of the hiccup reflex. Examples include stroke, tumour, traumatic brain injury, encephalitis, meningitis or multiple sclerosis.

What can help when you can’t stop hiccuping

Most cases of hiccups resolve by themselves quickly without any intervention. If hiccups are due to an underlying condition, treating this may resolve hiccups. 

Avoiding triggers that may cause hiccups

Avoid activities that bring on hiccups. This includes eating your food too fast and overeating. Stop when you are 80% full to avoid indigestion.

Reduce consumption of alcohol to within levels of moderation, quit smoking and find other alternatives to carbonated drinks. Avoid chewing gum, and find ways to reduce your stress levels by exercising and meditating.

How to get rid of hiccups using acupuncture

Acupuncture has been used in clinical practice in China for over 3,000 years and is gaining popularity in Australia. The mechanisms by which acupuncture is effective for hiccups remain unclear, but it is believed to improve circulation, activate the autonomic nervous system, reduce inflammation and encourage normal nerve transmission. It may also influence the ‘hiccup centre’ by modulating the secretion of certain hormones and neurotransmitters such as GABA, serotonin, noradrenaline and substances involved in reducing pain levels. Although only one study has been conducted, it may effectively treat people suffering from chronic hiccups.

Nutrients that may help

Although there are no nutrients that have been proven to be effective in hiccups, some of the following suggestions could theoretically be helpful for treating chronic cases of hiccups or in those who get frequent bouts.

To stop the diaphragm muscle spasming

Certain nutrients are important for proper muscular health, particularly in treating and preventing muscle spasms. The minerals magnesium, potassium, calcium, sodium and vitamin B6 are examples. Talk to your healthcare professional about supplementing your diet with magnesium, potassium and calcium if you think you may have a deficiency. Sodium can be added to foods by using good quality sea salt, but it is unnecessary for most people, especially those who suffer from high blood pressure.

In terms of herbal remedies, chamomile has been traditionally used to help in the treatment of muscle spasms.

Related reads:

• Why do newborns have the hiccups so often?
• Worried about farting too much? So is everyone else
• Worried about the effects of alcohol? You’re not alone

References

1. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hiccups 
2. http://www.mayoclinic.org/diseases-conditions/hiccups/home/ovc-20320112 
3. Chang FY, Lu CL. Hiccup: Mystery, nature and treatment. J Neurogastroenterol Motil. 2012 Apr;18(2):123-130  https://www.ncbi.nlm.nih.gov/pubmed/22523721
4. Ge A, Ryan M, et al. Acupuncture treatment for persistent hiccups in patients with cancer. J Altern Complement Med. 2010 Jul; 16(7): 811–816 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035062/
5. Hechtman L (2014). Clinical Naturopathic Medicine. Churchill Livingstone, Australia
6. Quiroga, J. B., García, J. U., & Guedes, J. B. (2016). Hiccups: a common problem with some unusual causes and cures. British Journal of General Practice, 66(652), 584–586. https://doi.org/10.3399/bjgp16x687913
7. Nguyen, V., Deeb, K., & Rathakrishnan, R. (2020). Hiccups: You got to be kidney me! SAGE Open Medical Case Reports, 8, 2050313X2096264. https://doi.org/10.1177/2050313x20962641
8. Becker, D. E. (2010). Nausea, Vomiting, and Hiccups: A review of Mechanisms and treatment. Anesthesia Progress, 57(4), 150–157. https://doi.org/10.2344/0003-3006-57.4.150
9. Li, A., Jiang, X., Zhong, M., Li, N., Tao, Y., Wu, W., Yang, C., Wang, H., Min, L., Ma, Y., & Deng, W. (2020). Intractable Hiccups as a Rare Gastrointestinal Manifestation in Severe Endocrine and Metabolic Crisis: Case Report and Review of the Literature. Therapeutic Advances in Endocrinology and Metabolism, 11, Article 2042018820934307. https://doi.org/10.1177/2042018820934307
10. Jessen, A. B., Toubro, S., & Astrup, A. (2003). Effect of chewing gum containing nicotine and caffeine on energy expenditure and substrate utilization in men. The American Journal of Clinical Nutrition, 77(6), 1442–1447. https://doi.org/10.1093/ajcn/77.6.1442
11. Orlovich, D. S., Brodsky, J. B., & Brock‐Utne, J. G. (2018). Nonpharmacologic management of acute singultus (Hiccups). Anesthesia & Analgesia, 126(3), 1091. https://doi.org/10.1213/ane.0000000000002789
12. Egbu, E., Ihemedu, C., Eze, U. A., Nwajei, C., & Ikponmwosa, M. (2021). Steroid-Induced Hiccups in a Patient Managed for Pseudo Foster-Kennedy Syndrome: A Case Report of Good Outcome With the Use of Gabapentin. Cureus, 13(1), Article e12893. https://doi.org/10.7759/cureus.12893
13. Karakonstantis, S., Pitsigavdaki, S., Korela, D., & Galani, D. (2018). Lower lobe pneumonia presenting as singultus (hiccups). PubMed, 9(4), 403–405. https://doi.org/10.22088/cjim.9.4.403
14. Freiha, J., Riachi, N., Chalah, M. A., Zoghaib, R., Ayache, S. S., & Ahdab, R. (2020). Paroxysmal Symptoms in Multiple Sclerosis—A review of the literature. Journal of Clinical Medicine, 9(10), 3100. https://doi.org/10.3390/jcm9103100
15. Keane, J. R. (2010). Hiccups due to Central Nervous System Disease: Analysis of 71 Inpatients. Canadian Journal of Neurological Sciences, 37(6), 870–872. https://doi.org/10.1017/s0317167100051611
16. Goyal, A., Pallavi, K., & Awasthy, A. K. (2022). Persistent Hiccups in Posterior Circulation Stroke as Rare Presentation of Pulmonary Embolism—Don't Jump the Gun. Indian Journal of Critical Care Medicine, 26(9), 1058–1059. https://doi.org/10.5005/jp-journals-10071-24303
17. Ehret, C. J., Almodallal, Y., Le-Rademacher, J. G., Martin, N. A., Moynagh, M. R., Rajotia, A., & Jatoi, A. (2022). Hiccups in patients with cancer: A multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. BMC Cancer, 22, Article 659. https://doi.org/10.1186/s12885-022-09760-5
18. Alderfer, B. S., & Arciniegas, D. B. (2006). Treatment of intractable hiccups with olanzapine following recent severe traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 18(4), 551–552. https://doi.org/10.1176/jnp.2006.18.4.551
19. Hou, L., Li, W., Li, H., Wang, Z., Guan, H., Ren, H., & Wang, P. (2022). Persistent hiccup as one of the initial symptoms of leucine-rich glioma-inactivated-1 encephalitis: a case report. BMC Neurology, 22(1). https://doi.org/10.1186/s12883-022-02797-w
20. Jadidi, A., Ashtiani, A. R., Hezaveh, A. K., & Aghaepour, S. M. (2022). Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complementary Medicine and Therapies, 23(1). https://doi.org/10.1186/s12906-022-03814-8
21. Jung, A. P., Bishop, P. A., Al-Nawwas, A., & Dale, R. B. (2005). Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. Journal of Athletic Training, 40(2), 71–75. PMCID: PMC1150229. PMID: 15970952.
22. Srivastava, J. K., Shankar, E., & Gupta, S. (2010). Chamomile: A herbal medicine of the past with bright future. Molecular Medicine Reports, 3(6), 895–901. https://doi.org/10.3892/mmr.2010.377. PMCID: PMC2995283. PMID: 21132119.