Hiccups: A Medical Conundrum

Hiccups are a common annoyance. Most of the time they are a benign, self-limited condition that resolve on their own. Some of the time, however, they can become a persistent, chronic problem and, in these cases, might indicate a more serious underlying pathology. There are many theories about the pathophysiology of persistent hiccups – from problems with the central and peripheral nervous systems to post-operative diaphragmatic irritation to metabolic derangements. Psychogenic and idiopathic hiccups are other alternatives. There are also several theories about the pathophysiology of self-limited hiccups, but none are well-established. These include gastric distention, alcohol ingestion, smoking, ingestion of particular foods, ingestion of foods at the extremes of temperature, exposure of the body to a rapid temperature change, stress, and heightened emotions.

And the cure? Well, as with so many things in medicine, there is none. There are several laymen’s approaches to arresting hiccups that are often used by patients before seeking medical care, some of which rely on pharyngeal stimulation or interference with the normal respiratory cycle. These include: sipping ice water, gargling with water, biting a lemon, drinking water upside down, drinking water from the far side of a glass, a teaspoon of vinegar, a teaspoon of honey, and holding one’s breath. The list goes on. A letter to the editor, Granulated Sugar as Treatment for Hiccups in Conscious Patients, published in 1971 in the New England Journal of Medicine advocated for the use of one teaspoon of white granulated sugar, swallowed “dry.”

The medical anecdotes are not well-studied, but chlorpromazine – an antipsychotic – is perhaps the most widely accepted agent for the treatment of persistent hiccups. Metaclopramide may also demonstrate some benefit.

For patients with persistent hiccups, the inconvenience – and annoyance – can become unbearable. Hiccups can ultimately lead to weight loss or difficulty sleeping and thus have an impact on people’s lives. As we continue to advance our medical knowledge and skills, perhaps we should look back at one of the simple, familiar, age-old problem which remains very much a medical mystery.

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