Chronic Hiccups

Chronic Hiccups

Chronic hiccups are a bit of a mystery in the medical world. There are several theories on why we hiccup, but no real purpose to to hiccupping has been found. For this reason especially, they are a bit of a puzzle. Chronic hiccups are defined in many different ways, but generally one can be considered to have them if they get hiccup attacks frequently (daily) or if they have the hiccups for an extended period of time (two days or more). Chronic hiccups are split into two categories: Persistent or protracted hiccups last for more than 48 hours. Intractable Hiccups refers to an episode that lasts over a month. Such cases are rare, but do occur. The most infamous such case is that of Charles Osborne, the Guinness World Record holder for the longest hiccup attack who hiccupped an estimated 430 million times over the course of 68 years! There are several other notable cases, some of which will be discussed further on.

There are over a hundred theorized causes for intractable hiccups, and in many cases the cause remains unknown (idiopathic). Hiccups that go away with sleep and return shortly upon waking are thought to be psychogenic (caused by the mind), arising from fear, hysteria, shock, personality disorders, or other psychological conditions. Chronic hiccups can be a caue for concern as they may point to serious underlying conditions, such as:

  • Pregnancy
  • Irritation of the bladder
  • Uremia
  • Asthma
  • Bronchitis
  • Pneumonia
  • Pleurisy of the diaphragm
  • Gastroesophageal reflux disease (GERD)
  • Alcoholism
  • Surgery
  • Lesions
  • Pancreatitis
  • Hepatitis
  • Liver and kidney disorders
  • Various lung and brain tumors
  • Heart Attack

GERD is known to give babies hiccups on a frequent basis. For unknown reasons, intractable hiccups are more common amongst men - over 80% of reported cases have been in males. Severe hiccupping has the potential to become dangerous if it is so frequent or intense that it routinely interferes with sleeping, eating, or other daily routines. While you should not immediately jump to the worst conclusions, for these reasons, it is a good idea to see a doctor if you have hiccups which have lasted for several days.

Chronic Hiccups Treatment

Treatment for intractable hiccups can be somewhat complex. The first thing a doctor will do is check for any underlying conditions or illnesses. Medical protocol differs amongst doctors for treatment of intractable hiccups, however as there are over 100 reported causes for them, most will start with a wide-ranging full body physical. A doctor may perform blood tests, an ECG (heart tracing), and x-rays of the chest. If a condition is found (anything ranging from air trapped in the stomach to any of the more serious conditions listed previously), then that illness will be treated. Treating the illness will generally cure the hiccups.

In the case that no underlying condition can be found, then physicians can continue with a large number of treatments in increasing complexity. Treatments including medicine, ice therapy, carotid sinus massage (massaging the back of the throat), electrical stimulation, acupuncture, and a Nasogastric tube (a thin tube is inserted through the nose into the stomach to release trapped air) may be tried. In addition, local anesthetics such as Lidocaine can be used to numb the back of the throat and the nerves in that area thought to cause the hiccups. If none of these prove effective, a number of medications may help; among these are Chlorpromazine (Thorazine), Diazepam (Valium), Metoclopramide (Reglan), Phenytoin (Dilantin), and Baclofen. These treatments can be effective but can often have other adverse side effects. The only FDA approved drug for the palliation of hiccups is Chlorpromazine, which was developed over 50 years ago.

For extreme cases in which none of the available options have worked, there are a number of surgeries that can help treat chronic hiccups. These surgeries have varying levels of success, though their results are generally promising. One such surgery was offered to a patient, ‘Mr. Smith’. Mr. Smith had a case of chronic hiccupping with little to no respite that had all but ended his ability to eat, sleep, and even talk. Doctors at Louisiana State University implanted a Vagus Nerve Stimulator in his upper chest. The device electrically stimulates the vagus nerve, altering the nerve’s signals. The surgery reportedly costs over $20,000. Another option is an injection of local anesthetic to the phrenic nerve, known as a 'phrenic nerve block.' This treatment can be risky as the phrenic nerve aids the human body in breathing. Phrenic nerve blocks have been used as an effective treatment for chronic hiccupping in cancer patients.

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