How to fix those annoying HICCUPS

Feb 26, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Up next on Eye on Springfield! We bring you a man who has being hiccupping for 45 years!" The camera pans to a dejected looking guy on a couch. All he can blurt out between hiccups is a quiet, "Kill me, hic. Kill me, hic." This tiny fragment of a Simpson's episode has stuck in my brain for years. What would it be like to hiccup constantly for a day, a week, a year, or 45 years? I'm sure it would be terrible.

Hiccups are caused by the sudden and involuntary contraction of the diaphragm and the intercostal muscles. The diaphragm is the big sheet of muscle between the lungs and the stomach. The intercostal muscles are the muscles between the ribs. When these breathing muscles suddenly contract you draw in air quickly. This causes the voice box to slam shut which causes the "hic" sound. Hiccups occur at a frequency of 4 to 60 per minute and the frequency tends to remain constant for any one individual.

Hiccups happen to almost everyone at some point in their lives. Brief bouts of hiccups lasting less than 48 hours are common, but we don't have good numbers to say how often they occur or to which people. Hiccups seem to be more common in men and people who are taller. In most cases hiccups go away on their own with no lasting effects. But in some people, they can last a long time and lead to problems like poor nutrition, tiredness and reduced appetite.

If hiccups last longer than a month, they are called intractable hiccups. Among patients with advanced cancer it has been found that somewhere between 1-9% have intractable hiccups.

Hiccups that last less than 48 hours don't seem to be associated with any disease or condition. Causes of regular transient hiccups include having an overly full stomach, fizzy drinks and swallowing air such as when chewing gum. Hiccups lasting longer than 48 hours are rare. They can be associated with structural issues in the throat, infections, inflammatory disorders and problems with the nerves going to and from the diaphragm. Some disorders that have been associated with intractable hiccups include: strokes, encephalitis (inflammation around the brain), head trauma, goiter, and alcohol. There are some drugs that are associated with intractable hiccups. Although these side effect are rare, they include cancer chemo like carboplatin, dexamethasone and diazepam.

To try to make your hiccups go away on your own, there are a few things you can try. You can hold your breath for as long as possible. Breathe out against your closed mouth and nose (the way you might do on an airplane to pop your ears). Stimulate the back of your throat. This can include things like sipping really cold water, gargling with really cold water or swallowing a teaspoon full of sugar. You can also compress your chest by pulling your knees up to your chest and leaning forward.

If the self-help measures don't cure your hiccups, there are medications that your doctor can prescribe. Often the doctor will start with a proton pump inhibitor or PPI. These have names like omeprazole and rabeprazole. These medications reduce stomach acid and can be helpful if the person with hiccups also has GERD or gastroesophageal reflux disease. That means there is stomach acid splashing up out of the stomach into the esophagus.

Other medications that can be tried include: baclofen, gabapentin, metoclopramide and chlorpromazine. These are all quite different medications but have been successful in some case of hiccups. Baclofen is a muscle relaxant often used in MS. Gabapentin is often used in neuropathic pain. Metoclopramide is often used for nausea. Chloropromazine is an older medication used for schizophrenia. We aren't really sure why they sometimes work for hiccups, but they all seem to effect the nerve loop that tells the diaphragm to contract again and again and again.

When everything else has failed, more unusual things have been tried. There are cases where the patients had a breathing pacemaker installed. This small electronic device controls how the diaphragm contracts with a small electric signal somewhat like how a pacemaker for the heart works. There have also been surgical cases where the nerve that feeds the diaphragm has been blocked.

"Nurse Maggie. Begin the preparation of the secret hiccup elixir. Milk, ice cream, maple syrup, tin of broccoli, hot sauce." As Lisa Simpson calmly pours this goo down her brother's throat, he initially seems cured of his hiccups. But they return. "Just as I feared" Lisa chirps, "not enough hot sauce." It can feel this way with intractable hiccups as well. We kind of throw everything in the pantry at them and hope something sticks.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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The Simpsons Hiccuping man -

The Simpsons - Lisa and Maggie Cure Bart of Hiccups -

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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