Hiccups that don't go away after 48 hours can persist but after a month, they're called intractable. Also called intractable sigultus, the word means "gasp" or "sob" in Latin. And if your hiccups don't stop, it can be hard to talk, sleep, eat, or drink. In serious cases, intractable hiccups can cause weight loss, fatigue, anxiety, and depression.
We all get hiccups once in a while. Usually hiccups last for a few minutes, then go away. Your diaphragm can twitch and rhythmically jerk to hiccup. If your hiccups go on for longer than 48 hours, talk to your doctor. These “persistent” or “protracted” hiccups could be a sign of a health problem.
But in very rare cases, your hiccups become chronic, lasting longer than a month. The longest recorded case of intractable hiccups continued for 60 years. Intractable hiccups are very rare — happening in about 1 in 100,000 people. About 4,000 people go to the hospital for hiccups each year in the U.S.
And about 91% of people who have intractable hiccups are men. Having hiccups for a long time can exhaust you. They can disrupt your sleeping and eating patterns, too. Intractable hiccups may also cause irregular heartbeat and gastroesophageal reflux disease (GERD). Find out the causes, treatments, and medications for intractable hiccups.
What Causes Intractable Hiccups?
You hiccup when your diaphragm jerks. Your diaphragm is a thin sheet of muscle that separates your chest and abdominal (belly) cavity. Once this muscle twitches, you suddenly suck in air. And this quickly closes your glottis (center of your voice box) to make a "hic" sound.
It's fairly constant. You can have 4-60 hiccups in a minute. That's because your hiccups are part of a reflex. Normally, your breathing is controlled by your brain, nerves, and your diaphragm. But if any injury, infection, or inflammation disrupts this reflex, it can trigger intractable hiccups.
Many conditions can lead to hiccups. Inflammation, irritation, or medication can interrupt the reflex to cause intractable hiccups.
Here are some possible causes:
Central nervous system changes. Brain tumors and strokes can compress structures in your brain, causing intractable hiccups. It's less common, but chronic hiccups can also happen with brain infections and vascular disease.
Nerve irritation. Stomach conditions can inflame your esophagus, stomach, and intestines. GERD, peptic ulcers, or stomach cancer can irritate your nerves and trigger hiccups. And you can get hiccups if you overeat, drink carbonated drinks, or swallow air while chewing.
Similar to stomach irritation, conditions that inflame your esophagus also raise your risk for hiccups. Procedures that insert a balloon in your throat can raise your risk for hiccups by 40%.
Other medical conditions. Other medical conditions can also irritate your diaphragm or the membrane inside your chest cavity (pleura). These conditions can raise your risk for hiccups if you get:
- Pneumonia
- Pleurisy (impacts the pleura)
- Goiter
- Tumor or cyst in your neck
- Liver, kidney, or heart problems
- Pancreas and gallbladder inflammation
Many of these conditions can irritate the phrenic nerve (the nerve that controls your diaphragm). If this nerve gets inflamed, it can trigger more hiccups than normal.
Medication triggers. Some medicines can affect your nerves. The medications can sometimes trigger the phrenic nerve and cause hiccups.
Medications that can cause hiccups:
- Dexamethasone (Ozurdex, Maxidex, DexPak)
- Benzodiazepines (a type of depressant)
- Barbiturates (a type of depressant)
- Tramadol (ConZip, Ultram) a type of pain medication
- Anticancer treatments such as carboplatin (Paraplatin), fluorouracil (Adrucil), irinotecan (Camptosar), levofolinate (Khapzory, Levoleucovorin), and oxaliplatin (Eloxatin)
- Alpha methyldopa (Aldomet) treats high blood pressure
- Anesthetics (make you unconscious or relieve pain)
Metabolic disorders. Certain minerals can get out of balance. These are called metabolic disorders and can cause hiccups, too. When your body can't break down certain nutrients into energy, hiccups may occur more often.
You can get more hiccups with:
- Low sodium (hyponatremia)
- Low potassium (hypokalemia)
- Low calcium (hypocalcemia)
- Low carbon dioxide (hypocapnia)
Mental health and hiccups. Mental conditions such as anxiety, stress, or excitement can stimulate hiccups. These psychogenic factors may raise your hiccup risk and disrupt sleep.
Intractable hiccups can also be triggered by spicy foods, hot liquids, fumes, and surgery. Talk to your doctor about your medical history. They'll likely order blood tests, imaging, and other studies to find the cause. But sometimes, a cause can't be found.
How to Treat Intractable Hiccups
Your doctor may first suggest some self-help techniques.
You can try these exercises to stop your hiccups:
- Take a deep breath and hold it for 5-10 seconds (or as long as you can). Repeat three to five times.
- Sip or gargle very cold water.
- Pull on your tongue for three to five seconds.
- Swallow a teaspoon of dry sugar.
- Bite into a slice of lemon.
- Close your eyelids and press gently but firmly on your eyeballs.
- Sit and pull your knees up to your chest. Hold this position for 30 seconds.
- To activate your phrenic nerve, drink water through a rigid tube with a valve. This requires a lot of suction effort. It's called the forced inspiratory suction and swallow tool (FISST).
- Perform the Valsalva maneuver:
- Sit or lie down in a comfortable position.
- Inhale, taking in a deep breath.
- Pinch your nose to keep your airway shut and close your mouth.
- Try to exhale, like you're blowing a balloon up, but keep your mouth and nose sealed.
- Hold the pressure for 10-15 seconds.
- Release your nose and mouth, and breathe normally.
Your doctor may also review your medical history and ask about recent surgeries. Your doctor may also look at your ears, neck, and head. They'll make sure you don't have an infection and rule out any reflux issues. They may also listen to your chest and check your lymph nodes. Your doctor will feel your neck and chest for any lumps or bumps.
Medication for Intractable Hiccups
Although doctors have yet to find a cure for hiccups, several treatments can help. All medications used for hiccups can cause side effects. So, talk to your doctor about which one may be the best one for you.
If your hiccups are intractable and imaging scans don't reveal a cause, your doctor may prescribe:
- A proton pump inhibitor for GERD
- Baclofen is a muscle relaxant
- Gabapentin (Neurontin, Gralise, Horizant)
- Metoclopramide (Reglan, Gimoti, Metozolv ODT)
In some cases, your doctor may suggest chlorpromazine (Thorazine). But this medicine carries a higher risk of tardive dyskinesia and may not be the best option if you're older.
Your doctor may prescribe your medicine for 5-10 days to start. If your hiccups stop, your doctor may stop your treatment. But if you still have hiccups, your doctor may continue your treatment for a few weeks.
If the first medication doesn't work for you, your doctor may switch it after three or four weeks. Sometimes, your doctor may combine medicines. Once your hiccups improve, the dose can slowly be lowered until you can stop taking your medicine. But talk to your doctor if your hiccups return.
Surgery for Intractable Hiccups
In rare cases, medication may not offer long-term relief. This means your doctor may suggest another treatment plan, such as:
- Hypnosis
- Acupuncture
- Surgery
Although the benefits are still unclear, acupuncture and hypnosis are generally safe to try. Rarely, your doctor may suggest surgery. A few case studies report temporarily or permanently blocking the phrenic nerve may help your hiccups subside. Talk to your doctor about which procedure works best for you.
Takeaways
Intractable hiccups are hiccups that last more than a month. These hiccups can make daily life hard and, in serious cases, cause weight loss, fatigue, anxiety, and depression. Medical conditions, medications, metabolic disorders, and more can cause chronic hiccups. If your hiccups aren't going away after two days, talk to your doctor to find out what may be causing your hiccups.
Intractable Hiccups FAQs
What part of the brain controls hiccups?
Your brain stem controls hiccups. It's the lower part of your brain that sends signals down the phrenic nerve. The phrenic nerve controls your diaphragm, a thin sheet of muscle that separates your chest and abdominal (belly) cavity.
Your brain stem, phrenic nerve and diaphragm make up the reflex arc. But if any injury, infection, or an inflammatory disorder disrupts the reflex, you get hiccups. Once your diaphragm twitches, you suddenly suck in air to quickly close the center of your voice box (glottis) to make a "hic" sound --- that's a hiccup.
Can we die from intractable hiccups?
You can't die from intractable hiccups. But your chronic hiccups can be caused by a life-threatening condition that requires treatment. If you've had hiccups longer than two days, talk to your doctor to find out what's causing them. Your doctor can treat any medical conditions that may be causing your hiccups.
How can you get rid of hiccups using pressure points?
Applying pressure to certain points on the body can sometimes help relieve hiccups.
Your jaw point:
- Place your pointer finger into the small indent below your ear lobe, behind your jawbone.
- Gently press for one to two minutes.
- Take a deep, slow breath.
Always talk to your doctor about doing acupressure on yourself. Especially if you have arthritis, a joint condition, or recent surgery.
