What Are Intractable Hiccups?

We all get hiccups once in a while. But they usually last for a few minutes, then go away.

In extraordinarily rare cases, hiccups can last for more than a month. These are known as “intractable hiccups.” Other terms to describe the same condition include “chronic hiccups” and “intractable singultus” -- which is another way to say hiccups.

The longest recorded case of intractable hiccups continued for 60 years. Intractable hiccups are very uncommon -- happening in about 1 in 100,000 people.

You should see your doctor if you have hiccups that go on for longer than 48 hours. This could be a sign of a health problem.

Hiccups that last more than 48 hours are called “persistent” or “protracted” hiccups.

Having hiccups for a long time can cause exhaustion, dehydration, and weight loss due to disrupted sleeping and eating patterns. It has also been known to cause irregular heartbeat and gastroesophageal reflux disease (also known as GERD), which occurs when the contents of your stomach come back up into your esophagus or mouth.

Causes

Finding a cause for your intractable hiccups may be a long process.

Intractable hiccups are not inherited, as most cases pop up in people without any family history.

You’ll have to talk to your doctor about your medical history and may have to go through blood tests, imaging, and other lab studies to find the cause. In some cases, a cause is never determined.

Intractable hiccups can be triggered by spicy foods, hot liquids, fumes, and surgery. They can also be associated with hundreds of conditions including the following:

  • Diseases affecting the diaphragm (the muscle separating the chest and abdominal cavities), pneumonia, and pleurisy (a condition affecting the pleura, the inside membrane of the chest cavity and tissue around the lungs)
  • Brain infections, injuries, tumors, or strokes
  • Metabolic disorders (when your body can’t break down certain nutrients into energy, causing a buildup)
  • Gastrointestinal diseases affecting the esophagus, stomach, or small or large intestines
  • Psychological problems such as hysteria, shock, fear, and certain mental conditions
  • Liver problems
  • Kidney disorders
  • Medications including chemotherapy, benzodiazepines (type of depressants), corticosteroids (used to treat inflammation), barbiturates (type of depressants), morphine (pain medication), and anesthetics (make you unconscious or relieve pain)
  • Surgery

Continued

Treatment

The most effective way to stop intractable hiccups is to find the root medical cause and address that issue. Treatments to stop intractable hiccups can involve medications, non-medical therapies, or surgery.

Self-help techniques, such as sipping ice water, holding your breath, biting a lemon, swallowing sugar, breathing into a paper bag, or pulling your knees to your chest are usually tried first if no correctable cause can be found. Your treatment will depend on your case and your medical needs.

Medications

Although generations of doctors have yet to find a definitive cure for hiccups, there are several different treatments that can be effective.

All medications used for hiccups can cause side effects, so talk to your doctor about which one may be the best one for you. Medications used to treat intractable hiccups include:

  • Baclofen (Gablofen, Lioresal) a muscle relaxant
  • Chlorpromazine a medicine used to treat psychiatric illnesses
  • Haloperidol, a type of tranquilizer
  • Metoclopramide (Reglan), used to treat problems in the esophagus and GERD
  • Anticonvulsant drugs such as phenytoin, valproic acid (Depakene, Depakote, Depakote® ER, Depakote® Sprinkle), gabapentin (Horizant, Neurontin), and carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • Sedatives
  • Pain medication
  • Stimulants

Your doctor may prescribe one of these medications for several weeks, raising the dose until your hiccups decrease. The dose may be slowly reduced until you can stop taking the medicine.

Talk to your doctor if the hiccups return after you stop taking the medication.

In rare cases, medication may not be effective in treating hiccups. This means your doctor may suggest another treatment plan.

Alternative Treatments

Surgery

If none of these treatments is effective, your doctor may suggest surgery.

The procedure could temporarily or permanently block the phrenic nerve in the neck. The phrenic nerve runs from the spinal cord to the diaphragm, causing it to contract and relax. This step is usually only taken when all other therapies have failed.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 15, 2019

Sources

SOURCES:

National Health Service: “Hiccups.”
National Organization for Rare Disorders: “Hiccups, Chronic.”
Orphanet: “Chronic Hiccup.”
NIH Genetic and Rare Disease Information Center: “Chronic Hiccups.”
UpToDate: “Acid Reflux Gastroesophageal Reflux Disease.”
Cedars Sinai: “Paralyzed Diaphragm.”
Mayo Clinic: “Pleurisy.”
Medscape: “Hiccups Treatment & Management.”
National Cancer Institute: “NCI Dictionary of Cancer Terms.”

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