A few years back, I distinguished myself with my usual, almost-daily case of hiccups in a quiet professional setting. I've never figured out what causes them, but they are a consistent irritant, both for me and my colleagues.
"Hic. Hic. Hic."
I tried to keep quiet, but trying to hold in a hiccup tends to work about as well as holding in a sneeze. One afternoon my editor had enough, and she came barreling out of her office toward my desk.
"You know, I'm waiting on your draft of that feature," she said, no mirth in her eyes at all.
I was sure it was due the next week. It was—and I was also done hiccupping, thanks to the moment of manufactured terror. (That's the only time the ol' scare trick has worked on my hiccups.) I've had hiccups so percussive that my intercostal muscles and solar plexus ached. I've earned looks of disgust from a cat who'd just settled onto my lap. And I've annoyed most people who spend time with me.
For most folks, hiccups are a minor annoyance: a tell that you've been drinking or are excited about something. They're a distinctly male affliction, with men out-hiccupping women a rate of 4 to 1. Babies hiccup in utero, and their tiny spasms show up on ultrasounds. They cause about 4,000 hospitalizations in the US every year.
And there's not really much medicine can do for them. Generally, they go away on their own. Sometimes they can last for weeks or months, which typically means there's an underlying problem. You can die from them, but it's exceedingly rare.
"A hiccup is an involuntary spasmodic contraction of the diaphragm and the intercostal muscles," says Dawn Davis, a family physician practicing with SLUCare Physician Group at Saint Louis University. "When you do that, it causes you to take a sudden deep breath, and your glottis closes. It makes you go 'hic.' Frequently, they don't mean anything."
The explosive little outbursts fall into three categories. A bout is anything that wraps up within 48 hours—and a bout is really no big deal. Typically, bouts are caused by gastric distension—the medical term for a belly full of air—that can arise from stuffing too much food into your face, drinking too many bubbly sodas, or smoking. Another possible cause is irritation of your eardrum, from an ear infection, a rogue hair, or a stray fiber from those damn Q-Tips you've been warned about.
They are also a common passenger on drinking adventures. With drinking, it's a mélange of causes, Davis says. You could be on beer number three (six) which means there's just a lot of liquid—and maybe carbonated liquid—sloshing around in the old tum. You could be extra chatty, which could be moving extra air inside you. Or you could be smoking, which introduces air as well—regular smokers light up when they drink, and there's the only-when-drinking smoking phenomenon, too.
If they go on, it's time to get serious about what might be causing them, and seek medical attention. "If they get to 48 hours, at that point you've got persistent hiccups and you should definitely go see your doctor," Davis says. "Start with your primary care doctor."
It's not time to start fully freaking out yet, though. Persistent hiccups can still have the same causes as a regular old bout. That said, you can freak out a little if they just won't quit: "It would be fair to say that hiccups lasting more than 48 hours can be serious," Davis says. After a month of irritating those around you and being subjected to everyone's grandma's can't-fail home remedies, you've officially got intractable hiccups. And that's a real problem.
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Davis says she knows of a few cases where people have hiccupped themselves off this mortal coil. Their deaths were probably really from the stress and malnutrition, she says. Hiccups have been shown as indicators for between 40 and 100 diseases, Davis says, so a case that's really lingering could be an indication of serious health problems like central nervous system or metabolic disorders, or nerve damage. They show up in patients with chronic illnesses like cancer, but typically well after diagnosis.
Regardless of the underlying cause, the physical act of hiccupping can cause issues after a while, too. "You can definitely get injured if you're having continual hiccupping," Davis says. You could strain muscles, and Davis adds there have been a few reported cases of hiccup-induced tearing in the esophagus. Hiccups can keep the hiccupper (and their partner, and their very annoyed pets) up all night, leading to all the crappy outcomes of missed zzz's. Or, she says, they can lead to malnutrition when a person can't get enough food past their hiccups.
"There are medications you can use, but none of them are great," she says. Typical medications used to treat long-term hiccups, according to the Mayo Clinic, are the muscle relaxer Baclofen; antipsychotic Chlorpromazine; and Metoclopramide, which increases muscle contraction in the upper digestive tract and is typically used to treat reflux.
A 2014 report in Pharmacotherapy looked at the case of a 59-year-old kidney transplant recipient with intractable hiccups after his transplant. (Post-surgical hiccups, Davis says, can cause surgical wounds to open.) He was eventually successfully treated with Baclofen and the antipsychotic Olanzapine. The report cited other studies of success treating cases of persistent or intractable hiccups with the Heimlich maneuver, sex, acupuncture, and nerve stimulation.
One patient report cited was a 67-year-old man with intractable hiccups after triple bypass surgery. His hiccups weren't responding to drugs, and he also had tachycardia—an abnormally fast heartbeat. His doctors found that cardioversion—sending electrical shocks to his heart through electrodes on his chest—fixed the speedy heart and cleared up his hiccups.
For most of us, however, it never gets that far. Most people have a go-to remedy: hold your breath, breathe into a bag, gargle ice water. All of them seem to work, kind of. "Or it just distracts you and it just goes away on its own," Davis says.
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