What Causes Hiccups and How to Stop Them

Abstract

Hiccups, though often dismissed as harmless and temporary, can be deeply distressing and, in rare cases, indicative of underlying health conditions. This paper explores the multifactorial causes of hiccups, from benign triggers such as overeating to severe neurological and gastrointestinal conditions. We investigate the complex pathophysiology involving the hiccup reflex arc, explore culturally diverse real-world case studies, and present evidence-based, practical interventions that can help stop hiccups. The article is designed to educate patients and communities globally—especially in Africa, Asia, and Latin America—on how to understand and manage hiccups at home, while recognizing when medical attention is needed.

Keywords: Hiccups, Diaphragm, Phrenic Nerve, Vagus Nerve, Pathophysiology, Community Health, Patient Education, Global Health

Introduction

Everybody, at some point in life, has experienced the annoying hic sound that bursts out of the chest, often during meals or laughter. Whether you’re in Nairobi, New Delhi, Lagos, or Lima, hiccups—called singultus in medical language—cut across all human experiences. But while they mostly disappear on their own, some hiccups can linger for days, weeks, or even months, affecting sleep, appetite, and overall health.

In this article, we go beyond the old wives’ tales and explore the actual science of hiccups, their causes, their pathophysiology, and the many ways—scientific and home-based—that people across the world try to stop them.

Understanding Hiccups: The Science and the Sound

What Exactly Are Hiccups?

Hiccups are involuntary, spasmodic contractions of the diaphragm—the large muscle that separates the chest from the abdomen and plays a big role in breathing. When the diaphragm suddenly contracts, the vocal cords snap shut quickly, producing the familiar “hic” sound (Sharma & Tiwari, 2022).

This simple action is controlled by a complex nerve circuit called the hiccup reflex arc, which includes:

• The phrenic nerve (from the neck to the diaphragm)
• The vagus nerve (which connects the brain to the gut and heart)
• Parts of the brainstem (especially the medulla oblongata)
• Spinal cord segments C3–C5 (where the phrenic nerve originates)

When anything irritates or overstimulates any part of this reflex arc, a hiccup can occur (Kahrilas et al., 2021).

Causes of Hiccups: From Harmless to Alarming

Hiccups are typically grouped into three types based on how long they last:

• Acute hiccups: Last less than 48 hours
• Persistent hiccups: Last more than 48 hours
• Intractable hiccups: Last over a month

Let’s take a closer look at what causes each of these types.

1. Common Causes of Short-Term Hiccups

These are the types most people are familiar with:

• Overeating or eating too fast: Swallowing large amounts of air or stretching the stomach can irritate the diaphragm.
• Carbonated drinks: They introduce gas into the stomach.
• Hot or spicy foods: These can irritate the vagus nerve or esophagus.
• Sudden changes in temperature: For example, eating hot food then drinking cold water.
• Emotional stress or excitement: Anxiety, laughter, or nervousness may trigger hiccups.

Case Example – Nairobi, Kenya:
A 14-year-old girl named Achieng developed hiccups during her birthday party after laughing while drinking soda and eating spicy samosas. Her hiccups stopped after a few minutes of holding her breath and drinking water—an example of benign, self-limiting hiccups.

2. Persistent and Intractable Hiccups: When It’s Not So Simple

These are often caused by medical conditions and should never be ignored.

Neurological Causes:

• Stroke, brain tumors, multiple sclerosis, encephalitis
• Damage to the brainstem, especially near the medulla (Feldman et al., 2020)

Gastrointestinal Causes:

• Gastroesophageal reflux disease (GERD)
• Gastritis, peptic ulcers
• Hiatal hernia
• Bowel obstruction

Thoracic Causes:

• Pneumonia, asthma, pleurisy
• Pericarditis

Metabolic and Systemic Causes:

• Kidney failure (uremia)
• Electrolyte imbalances (low calcium, potassium, or sodium)
• Diabetes (especially with gastroparesis)

Psychogenic Causes:

• Mental health disorders like anxiety or schizophrenia
• Intense grief or trauma

Medication-Induced Hiccups:

• Chemotherapy drugs (e.g., cisplatin)
• Steroids (e.g., dexamethasone)
• Benzodiazepines (e.g., lorazepam)

Case Study – Mumbai, India:
Mr. Rajesh, a 58-year-old retired teacher, experienced hiccups that lasted for over three days. He visited the clinic after home remedies failed. Investigations revealed he had a gastric ulcer irritating the diaphragm. Treatment with proton pump inhibitors (PPIs) like omeprazole resolved both the ulcer and the hiccups.

The Pathophysiology of Hiccups: What’s Going On Inside the Body?

To understand why hiccups occur, we must trace the hiccup reflex arc:

1. Irritation or stimulation begins anywhere along the reflex arc: the stomach, lungs, or brainstem.
2. A message travels via the vagus or phrenic nerve to the spinal cord.
3. The signal is processed by the medullary hiccup center in the brainstem.
4. It triggers a sudden contraction of the diaphragm and intercostal muscles (the ones between the ribs).
5. Simultaneously, the vocal cords close, producing the “hic” sound (Bajaj & Sikka, 2021).

This reflex is involuntary and typically self-limiting, unless one of the components is continuously irritated.

What Can Stop Hiccups? Evidence-Based and Home Remedies

Let’s face it—most people try random methods they heard from a friend or elder. Surprisingly, many work because they either stimulate the vagus nerve or disrupt the hiccup reflex.

Simple Home Remedies

1. Holding your breath: Increases carbon dioxide in the blood, which may stop hiccups.
2. Drinking cold water slowly: Soothes vagus nerve and diaphragm.
3. Swallowing a spoonful of sugar or honey: Stimulates the oropharynx.
4. Pulling the tongue or gargling: Triggers vagus stimulation.
5. Breathing into a paper bag: Again, raises carbon dioxide.

Case in Uganda – Gulu Hospital:
A patient with persistent hiccups after malaria treatment responded well to the “honey and lemon” remedy recommended by a local nurse. While scientific backing is limited, such remedies may help stimulate the vagus nerve.

Medical Interventions for Persistent Hiccups

If hiccups last more than 48 hours or interfere with eating or sleeping, medical treatment is needed.

• Chlorpromazine (Thorazine): FDA-approved for hiccups (Kahrilas et al., 2021)
• Metoclopramide: Helps with gastrointestinal motility
• Baclofen: A muscle relaxant that can calm the diaphragm
• Gabapentin: Useful in neurologically-induced hiccups

Note for Rural Clinics: In places with limited resources, start with antacids if GERD is suspected, and refer for imaging if no improvement.

Psychological Support and Cultural Beliefs

In some African and Asian cultures, hiccups—especially when persistent—may be attributed to spiritual forces or curses. While it’s important to respect cultural beliefs, health workers must offer scientific explanations with empathy.

Example – Lagos, Nigeria:
A young man was brought to a faith healer for hiccups lasting a week. He was later referred to a hospital where a CT scan revealed a brain tumor. The hiccups were early neurological symptoms.

When to Worry: Red Flags for Patients and Families

• Hiccups lasting more than 48 hours
• Associated with vomiting, chest pain, or confusion
• Interfering with sleep, eating, or daily function
• Occurring after head injury or stroke
• In people with chronic diseases like diabetes or cancer

Conclusion: A Small Sound, A Big Signal

Although hiccups may seem like a minor nuisance, they can sometimes be the body’s cry for help. Knowing when to ignore them and when to investigate further is vital for patients and healthcare providers alike.

Across the globe—from the bush clinics of rural Africa to urban hospitals in Europe—people experience hiccups. Let us normalize conversations around them, educate the public, and train community health workers to spot the signs that matter.

References (APA 7th Edition)

Bajaj, S., & Sikka, P. (2021). Hiccups: A diagnostic challenge. Journal of Clinical Gastroenterology, 55(3), 238–243.

Feldman, R. S., Chen, A., & Liu, J. (2020). Persistent hiccups: Clinical review and neuroanatomical analysis. Neurology International, 12(4), 205–214.

Kahrilas, P. J., Pandolfino, J. E., & Vela, M. F. (2021). Understanding hiccups: Pathophysiology and practical management. The Lancet Gastroenterology & Hepatology, 6(10), 795–805.

Sharma, A., & Tiwari, P. (2022). Hiccups: An overview of pathogenesis and treatment. International Journal of Medical Science and Research, 10(1), 45–52.