Hiccups are inappropriate respiratory muscle contractions that can occur due to gastrointestinal, respiratory, neurologic, and general systemic disorders as well as a sequel to surgery or adverse reaction to drugs. Among the neurologic lesions that can cause persistent hiccups, brainstem lesions figure prominently. Benign posterior fossa tumors can cause hiccups by compression of the brainstem. This is relieved following the removal of the tumors. This article describes the differential diagnosis and management of hiccups. If no lesion is found, hiccups can be controlled by some pharmacologic agents such as baclofen and gabapentin. Unconventional methods and surgical procedures to relieve hiccups are also described.
| || |
• Hiccups are inappropriate respiratory muscle contractions.
| || |
• Hiccups may due to several systemic as well as gastrointestinal and neurologic disorders such as brainstem lesions.
| || |
• Diagnosis of idiopathic hiccups is made after exclusion of identifiable causes.
| || |
• Management is mostly medical and baclofen is the most commonly used drug.
| || |
• Lesions compressing the medulla require surgical removal and some neuromodulation procedures, such as stimulation of the vagus nerve, may be considered for intractable hiccups.
Historical note and terminology
Hiccuping (singultus) derives from the Latin “singult,” meaning “to catch one’s breath while sobbing.” It is a common occurrence, but little is known about its pathophysiology. Although vomiting and coughing are protective reflexes of the gastrointestinal and the respiratory systems respectively, hiccuping seems to have no survival value. It may be a vestigial reflex in mature persons as a remnant of a primitive sucking reflex, as fetal hiccuping is a normal phenomenon, which has been demonstrated by ultrasonography in utero. Hiccuping may be serving a useful purpose by maintaining the activity of the respiratory muscles, which are superfluous at that stage of development.
The classification of hiccups is by their duration. Acute hiccups are less than 48 hours duration, persistent over 2 days, and intractable over a month. Idiopathic chronic hiccup is defined as recurring hiccup attacks that last for longer than 1 month, and for which no organic cause can be found. It is also called diabolic hiccup.
Hiccups were a mystery to early physicians, and some of the folklore methods of treatment have survived in modern practice such as breath-holding, gargling with water, or inducing sneezes. These may work by temporary halting the rhythm of respiration.