Hiccups - Symptoms, diagnosis and treatment

Last reviewed: March 2020

Last updated: August 2018

Summary

Hiccups is a common and mostly harmless condition.

Most hiccups are benign and self-limiting, rarely requiring medical attention. However, various organic and psychogenic causes can lead to persistent, intractable hiccups that can last for years.

Persistent intractable hiccups can lead to malnutrition, weight loss, dehydration, fatigue, depression, insomnia, and reduced quality of life.

Various therapies have been described, from non-prescription remedies to mechanical stimulation of the involved anatomical structures.

Unfortunately, most of the evidence for treatments of hiccups come from uncontrolled observational trials or case-control series or reports. Valid randomised trials are therefore needed to thoroughly investigate the effectiveness of therapies for this indication.

Definition

A hiccup is an abrupt contraction of the inspiratory muscles that repeats several times per minute. The resultant sudden rush of air into the lungs causes the glottis to close, creating a distinctive 'hic' sound.

History and exam

Key diagnostic factors

presence of risk factors
'hic' sound

More key diagnostic factors

Other diagnostic factors

duration <1 hour (benign hiccups)
duration >1 hour (persistent intractable hiccups)
persistence during sleep
associated features of underlying cause
weight loss and malnutrition

Other diagnostic factors

Risk factors

aerophagia, temperature changes, and emotional states
diaphragmatic and phrenic nerve irritation
vagus nerve irritation
central nervous system disorders
metabolic/electrolyte abnormalities
toxins/drugs
psychogenic disorders
sedation or anaesthesia

More risk factors

Diagnostic investigations

1st investigations to order

clinical diagnosis

More 1st investigations to order

Investigations to consider

FBC
serum electrolytes
urea
CRP and erythrocyte sedimentation rate
liver function tests
gamma glutamyl transpeptidase (gamma-GT)
serum amylase
toxicology screen
arterial blood gas
ECG
CXR
pulmonary function tests
CT abdomen
endoscopy of the upper gastrointestinal tract
CT or MRI head
lumbar puncture
otoscopy
pharyngoscopy

More investigations to consider

Treatment algorithm

ACUTE

benign hiccups

ONGOING

persistent intractable hiccups

Contributors

AuthorsVIEW ALL

Peter Kranke, MD, PhD, MBA

Professor of Anaesthesia

Department of Anaesthesia and Critical Care

University of Würzburg Hospital

Würzburg

Germany

Disclosures

PK is an author of a reference cited in this topic.

Yvonne Jelting, MD

Assistant Physician and Study Subinvestigator

Department of Anesthesia and Critical Care

University Hospital of Wuerzburg

Wuerzburg

Germany

Disclosures

YJ declares that she has no competing interests.

Acknowledgements

Professor Peter Kranke and Dr Yvonne Jelting would like to gratefully acknowledge Dr Thomas M. Metterlein, a previous contributor to this topic. TMM declares that he has no competing interests.

Peer reviewersVIEW ALL

Andy Smith, BM, BS, MRCP, FRCA

Consultant Anaesthetist and Associate Director of Research and Development

Director

Lancaster Patient Safety Research Unit

Royal Lancaster Infirmary

Lancaster

Disclosures

AS declares that he has no competing interests.

Stefan K. Burgdorf, MD

Registrar

Department of Surgical Gastroenterology

Herlev Hospital

University of Copenhagen

Denmark

Disclosures

SKB declares that he has no competing interests.

Howard Smith, MD, FACP

Academic Director of Pain Management

Associate Professor of Anesthesiology

Department of Anesthesiology

Albany Medical College

Albany

Disclosures

HS is an author of a reference cited in this topic.

Differentials
- Gasping
- Burping
More differentials

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