Most of the time they’re a minor annoyance — if that. They come, and they go, typically in a matter of minutes. But sometimes hiccups — an involuntary spasm or contraction of the diaphragm after…
Most of the time they’re a minor annoyance — if that. They come, and they go, typically in a matter of minutes. But sometimes hiccups — an involuntary spasm or contraction of the diaphragm after which vocal cords suddenly close, making the characteristic hiccup sound — go on and on.
In rare cases, hiccups last more than 48 hours — often called persistent hiccups, though definitions and terminology aren’t standardized — and may require medical attention. Some people even have hiccups that last more than 30 days, frequently referred to as intractable hiccups.
“Usually if it’s less than 48 hours, it’s transient, it’s benign; it shouldn’t require any type of specific further evaluation by a medical provider,” says Dr. Camielle Rizzo, an emergency room physician who’s also board-certified in hospice and palliative medicine at Middlesex Hospital in Middletown, Connecticut. There are, however, case studies of individuals who’ve had hiccups that, even in the short run, seemed to be the sole outward sign of an underlying health concern, like a heart problem. But that’s exceedingly rare and unlikely, clinicians say. Usually there are other indicators to go along with the hiccupping: “If one were having chest pain or trouble breathing or other worrisome symptoms with it, of course I would still recommend that that person seek care,” Rizzo says. The American Stroke Association lists hiccups among unique symptoms women may experience when having a stroke, along with other common symptoms like numbness or weakness in one side of the body or uncommon symptoms women may experience like hallucination.
Generally, where hiccups are most concerning from a health standpoint is when they persist over 48 hours, and especially when they last more than a month, Rizzo says.
Research finds that persistent and intractable hiccups tend to be linked to an underlying medical condition or disease. In addition to issues that are more commonly associated with hiccups like gastroesophageal reflux disease, or GERD, there are reports of people who had long lasting hiccups associated with cancer; septic arthritis, a joint infection; and pulmonary embolism — a blood clot in the lungs. “It seems like it could be any number of issues with the lungs, or anything that affects the diaphragm,” says Dr. Matthew Wodziak, an assistant professor of neurology at Loyola University Medical Center in Maywood, Illinois. And that’s just scratching the surface of what might irritate the so-called hiccup reflex arc — encompassing nerves that extend from the brain through the neck, chest and abdomen — which is thought to be responsible for hiccups.
In some cases, the underlying cause of hiccups has already been diagnosed when the hiccups begin, while in some instances the cause is more mysterious or difficult to determine. In either case, it’s worth taking a closer look when hiccups persist past 48 hours, experts say.
But because it’s not a common issue, treatment for it can be a matter of trial and error. “Hiccups are a common problem that crosses multiple disciplines including neurology, gastroenterology and pulmonology, and primary care,” according to a recent review of hiccup research and case studies, which Wodziak co-authored in the journal Current Neurology and Neuroscience Reports. There aren’t any formal guidelines for treating intractable hiccups, which is based on experience and anecdotal evidence, the review notes. However, “a number of medications and other therapy have been reported successful for intractable hiccups.” These include drugs like the muscle relaxant baclofen and gabapentin, which is used to treat seizures or convulsions.
Just as it’s worth undergoing a medical evaluation to try to determine the underlying causes for persistent and intractable hiccups — when that’s not already known — experts say there’s reason to consider treating these long-lasting hiccups. While not a threat to a person’s safety in and of themselves, when hiccups persist, they can seriously undermine quality of life.
Patients with intractable hiccups may experience issues including difficulty being able to eat or drink, Rizzo says. “There can be subsequent weight loss, the insomnia from having hiccups all night can be incredibly distressing, and then — not surprisingly — if you haven’t slept for two to three weeks, you can become depressed and anxious,” she adds.
Not that medical treatment is always needed to stop hiccups. There are some reports of people getting relief using alternative remedies, from the classics like breath-holding to hypnosis. One alternative remedy involves shooting vinegar up one’s nose — “which apparently worked really well but obviously doesn’t seem very pleasant,” Wodziak says. Another apparent remedy that worked in at least one instance when medications didn’t is a bit more pleasant: “Sexual intercourse was reported to relieve intractable hiccups in a 40-year old man who did not find relief with metoclopramide and chlorpromazine as well as palate massage,” Wodziak and co-author Dr. Stasia Rouse wrote in the Current Neurology and Neuroscience Reports review. “According to him, sex with his wife at the moment of ejaculation caused complete cessation of hiccups.”
Of course if you can’t get it done in the bedroom — or otherwise get rid of persistent and intractable hiccups at home — experts say it’s worth talking to a doctor about it. “Many times we’re able to either fix the underlying cause or manage the hiccups themselves with appropriate medication or therapy, and the patient has relief,” Rizzo says. “So it’s usually a good prognosis.”