Hiccups are a common and mostly harmless condition.
Most hiccups are benign and self-limiting, rarely requiring medical attention. However, various organic causes can lead to chronic hiccups that can last for years.
Chronic 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.
Most of the evidence for treatments of hiccups come from uncontrolled observational trials or case-control series or reports. Valid randomised trials are needed.
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
Other diagnostic factors
- duration <48 hours (typically benign hiccups)
- duration >48 hours (chronic hiccups)
- persistence during sleep
- associated features of underlying cause
- weight loss and malnutrition
- aerophagia, temperature changes, and emotional states
- diaphragmatic and phrenic nerve irritation
- vagus nerve irritation
- central nervous system disorders
- metabolic/electrolyte abnormalities
- psychogenic disorders
- sedation or anaesthesia
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum electrolytes
- C-reactive protein and erythrocyte sedimentation rate
- liver function tests
- gamma glutamyl transpeptidase (gamma-GT)
- serum amylase
- toxicology screen
- arterial blood gas
- chest x-ray
- pulmonary function tests
- CT abdomen
- endoscopy of the upper gastrointestinal tract
- CT or MRI head
- lumbar puncture
Use of this content is subject to our disclaimer