Hiccups are an ordinary inconvenience for most people, but they also can be a side effect of medication and a rare sign of a medical problem. A hiccup is due to an involuntary contraction of your diaphragm, followed by your vocal cords suddenly closing.
Ordinary short-term hiccups are most often caused by overeating, excessive alcohol intake, stress or excitement, or carbonated beverages. Long-lasting hiccups (lasting more than 48 hours) are sometimes caused by irritation or damage to the vagus or phrenic nerves. Irritation or damage to the vagus or phrenic nerves innervates the diaphragm.
Long term hiccups can also be due to medication/drug use or metabolic problems like kidney failure or gastrointestinal issues. Men are more likely to develop long-term hiccups than women.
Hiccups are considered intractable when they last for more than a month. This can be a serious problem because it is difficult to eat, breathe and sleep, thus causing malnutrition, slowed post-surgical healing and general distress. Intractable hiccups have been known to occur after traumatic brain injury as well as other medical or neurological issues. The cause is not always known.
Medications do not commonly cause hiccups, but there are many classes of drugs that have been implicated. Chemotherapy drugs, general anesthesia, steroids, sedatives, barbiturates, opiates, and anti-depressants are a few. This can be difficult to sort out because many of the medications are taken for health problems that can also cause hiccups.
Long-term hiccups are sometimes treated with medications, including antipsychotic meds such as haloperidol, olanzapine, or chlorpromazine, metoclopramide (an anti-nausea drug), or muscle relaxers such as liorasel. If drugs do not relieve the hiccups, sometimes a nerve block can be done. This involves injecting anesthesia to block the phrenic nerve. If the hiccups are severe and intractable, a nerve stimulator can be inserted. This is placed under the skin like a pacemaker, and delivers mild electrical stimulation to the vagus nerve.
Hiccups can be irritating but once they last for more than 48 hours, they can be a medical problem. Visit a health care provider to rule out metabolic and neurologic causes. Intractable hiccups are rare, but it is important to see a provider to have them treated in a timely manner to avoid complications.
Journal of Neuropsychiatry & Clinical Neurosciences