Hiccups are one of those minor maladies of man that they don't teach you about in medical school. But they can affect a person's life — particularly when they start at the wrong time. The first time I realized this was when hiccups started just as I was in the middle of giving a lecture to medical students. You want your lectures to be memorable, and this one may have been — not for what I said, but for the way it came out of my mouth. We know what hiccups are, but not why they occur. Each of us has a flat plate of muscle just beneath our lungs, separating our chest from our abdomen.
It's called the diaphragm, and it helps us breathe: when it moves downward, it causes the lungs to pull in air through the nose and mouth.
Hiccups: Practice Essentials, Background, Pathophysiology
And when it moves upward, it forces air out of our lungs. The movement of the diaphragm is directed by the brain, which sends signals down nerves that end in the diaphragm. A hiccup occurs when the brain sends a signal for the diaphragm to shift forcefully downward, suddenly pulling a lot of air into the back of the throat. The sudden change in pressure causes a narrow area in the throat to temporarily snap shut, causing the "hic" sound of a hiccup.
Why the brain sends the signals that cause hiccups, however, is a mystery. Several factors can trigger the short bouts of hiccups that many people periodically experience: 1 a stomach full of too much food, alcohol, or air; 2 sudden changes in temperature; 3 smoking cigarettes; 4 excitement, stress, or other heightened emotion like when giving a lecture. What to do? See Treatment and Medication for more detail. The term hiccup derives from the sound of the event; the alternative spelling hiccough erroneously implies an association with respiratory reflexes.
Brief episodes of hiccups, which often induce annoyance in patients and merriment in observers, are a common part of life. Prolonged attacks, however, are a more serious phenomenon and often pose a diagnostic dilemma. These attacks have been associated with significant morbidity and even death. A hiccup bout is any episode lasting more than a few minutes.
Hiccups lasting longer than 48 hours are considered persistent or protracted. The longest recorded attack of hiccups lasted for 6 decades.
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Hiccups appear to serve no purpose in humans or other mammals. Often, only a single hemidiaphragm is affected. Hiccups occur times per minute until a certain number has been delivered. Typically, this is fewer than four or more than The frequency is relatively constant for a given individual and varies inversely with arterial carbon dioxide tension PaCO 2. The loudness and rapidity of hiccups are unrelated. Hiccups are more common in the evening and may continue for a few waking hours.
They occur most frequently during the first half of the menstrual cycle, especially in the few days before menstruation, and become markedly less frequent during pregnancy. Despite centuries of contemplation, the exact pathogenesis of hiccups remains a mystery. Hippocrates and Celsus associated hiccups with liver inflammation and other conditions.
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Galen believed that hiccups were due to violent emotions arousing the stomach. In , Shortt first recognized an association between hiccups and phrenic nerve irritation. The cause of hiccups in children and infants is rarely found.
Brief episodes in adults are usually benign and self-limiting. Typical causes include the following:. Persistent or intractable episodes are more likely to result from serious pathophysiologic processes affecting a component of the hiccup reflex mechanism. More than causes have been described; however, in many cases, the cause remains idiopathic. Psychogenic conditions associated with hiccups include the following:. Conditions associated with irritation of the following branches of the vagus nerve irritation can cause hiccups:.
Procedure- or anesthesia-related causes of hiccups include the following [ 13 , 14 ] :. Hiccups can occur at any age.
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They may even be observed in utero; preterm infants spend up to 2. Although hiccups occur less frequently with advancing age, intractable hiccups are more common in adult life. Females develop hiccups more frequently during early adulthood than males of the same age do. A review of the literature comprising studies found a male predominance in hiccup patients, particularly when the causes were not related to the central nervous system or were unknown.
In general, hiccups are self-limited, and the prognosis is excellent. The prognosis of protracted hiccups is related to that of the underlying etiology. Protracted hiccups often are associated with underlying organic disease and often induce social and emotional distress. Therapy must address causative and complicating factors of protracted hiccups. Complications of hiccups may include the following:.
Wang T, Wang D. Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study. Intern Med J. Chronic hiccups: an underestimated Problem.
Anesth Analg. Hiccups: a common problem with some unusual causes and cures. Br J Gen Pract.
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Gender differences in hiccup patients: analysis of published case reports and case-control studies. J Pain Symptom Manage. Intractable hiccups as a presenting symptom of Chiari I malformation. Acta Neurochir Wien.
Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma. Eur Spine J. Hiccups as a myocardial ischemia symptom. Pol Arch Med Wewn. Morinaka S. Herpes zoster laryngitis with intractable hiccups. Auris Nasus Larynx. Yeatman CF 2nd, Minoshima S. Clin Nucl Med.
What Causes Hiccups?
Hiccup as a result of late lead perforation: report of two cases and review of the literature. Laparoscopic resection of an intradiaphragmatic bronchogenic cyst. Novel use of amantadine: to treat hiccups. Surgical complications in hair transplantation: a series of procedures.