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Hiccups

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 12 Apr 2025
Last updated: 12 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • "hic" sound
Full details

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
Full details

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 anesthesia
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • CBC
  • serum electrolytes
  • BUN
  • C-reactive protein and erythrocyte sedimentation rate
  • liver function tests
  • gamma glutamyl transpeptidase (gamma-GT)
  • serum amylase
  • toxicology screen
  • arterial blood gas
  • ECG
  • chest x-ray
  • pulmonary function tests
  • CT abdomen
  • endoscopy of the upper gastrointestinal tract
  • CT or MRI head
  • lumbar puncture
  • otoscopy
  • pharyngoscopy
Full details

Treatment algorithm

ACUTE

benign hiccups

ONGOING

chronic hiccups

Contributors

Authors

Aminah Jatoi, MD

Professor of Oncology

Department of Oncology

Mayo Clinic

Rochester

MN

Disclosures

AJ has received a grant review for Pfizer (money is paid to her institution) and research funding from AstraZeneca. AJ is on an advisory board for Meter Health and Novartis. AJ is an author of one reference cited in this topic.

Acknowledgements

Professor Aminah Jatoi would like to gratefully acknowledge Professor Peter Kranke, Dr Yvonne Jelting, and Dr Thomas M. Metterlein, previous contributors to this topic.

Disclosures

PK is an author of a reference cited in this topic. YJ and TMM declare that they have no competing interests.

Peer reviewers

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

UK

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

NY

Disclosures

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

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Lewis JH. Hiccups: causes and cures. J Clin Gastroenterol. 1985 Dec;7(6):539-52. Abstract

Wagner MS, Stapczynski JS. Persistent hiccups. Ann Emerg Med. 1982 Jan;11(1):24-6. Abstract

Rousseau P. Hiccups. South Med J. 1995 Feb;88(2):175-81. Abstract

Moretto EN, Wee B, Wiffen PJ, et al. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD008768.Full text  Abstract

Zhu LL, Wang WX, Guo XG. Acupuncture for hiccups after stroke: a systematic review. Chin J Evid Based Med. 2011;11:325-8.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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