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Hiccups

Hiccups are unintended spasms of the diaphragm followed by quick closing of the vocal cords. The closing of the vocal cords makes the sound of hiccups. The diaphragm is the main muscle used in breathing.

Causes

The exact cause of hiccups is not known. Hiccups may be caused by irritation of the nerves that control the muscles used for breathing, including the diaphragm. Hiccups affect men more often than women.

Common triggers of hiccups include:

  • bloated stomach – from overeating or drinking carbonated drinks
  • acid reflux
  • drinking alcohol
  • eating spicy food – like chili peppers
  • smoking
  • swallowing air
  • sudden emotional change – like overexcitement or anxiety

People with cancer may get hiccups for other reasons, such as:

  • esophageal cancer
  • brain tumours
  • systemic infection (affects the whole body)
  • pancreatic cancer
  • tumours of the mediastinum
  • surgery
  • medicines
  • electrolyte imbalance

Symptoms

Hiccups are described based on how long they last:

  • acute hiccups – last up to 2 days
  • persistent hiccups – last longer than 2 days
  • intractable hiccups – last longer than 1 month

Hiccups are usually acute and go away on their own within minutes or hours.

People with advanced cancer have a higher than average chance of getting persistent or intractable hiccups. Up to about 10% of people with advanced cancer get these long-lasting hiccups.

Persistent and intractable hiccups can have negative effects on your activities of daily living. They can interfere with talking, eating, drinking and sleeping. They can also affect your mood and can make your pain worse.

If your hiccups don’t go away, report them to your doctor or healthcare team without waiting for your next scheduled appointment.

Diagnosis

If you have persistent or intractable hiccups, your doctor will try to find the cause. They may ask you questions about your medical history and do a physical exam. It is usually difficult to find the exact cause of hiccups. If your hiccups last a long time for no obvious reason, you may need to have the following tests:

Managing hiccups

Acute hiccups

You can try the following to help relieve acute hiccups:

  • Breathe deeply and hold your breath.
  • Breathe deeply in and out of a paper bag.
  • Eat some dry bread, granulated sugar or crushed ice.
  • Gently pull on your tongue.
  • Stimulate your gag reflex (stick your finger in the back of your throat).

Persistent and intractable hiccups

Persistent and intractable hiccups can be difficult to treat. Your healthcare team may suggest the following ways to treat these hiccups.

Your doctor may prescribe medicines, such as:

  • baclofen (Lioresal)
  • chlorpromazine
  • metoclopramide (Metonia)
  • gabapentin (Neurontin)
  • proton pump inhibitors – for example, lansoprazole (Prevacid) or esomeprazole (Nexium)

Acupuncture may be effective for treating persistent or intractable hiccups.

To treat intractable hiccups, doctors may block or disrupt the signals in the nerves that control the diaphragm (called the phrenic nerves). There are several ways to do this:

  • inject a local anesthetic into the nerve
  • implant an electrode next to the nerve (called pulsed radiofrequency lesioning)
  • place clips on the nerve – may be permanent

Sometimes doctors may stimulate the nerves by using electrical signals. They may stimulate the vagus nerve, which helps control the diaphragm, and maybe the phrenic nerves too. There are 2 ways to stimulate the nerves:

  • a device is placed on the skin (transcutaneous stimulation)
  • a device is implanted under the skin on the chest

If other treatments fail, the doctor may cut the phrenic nerves (called a phrenicotomy) to permanently stop the nerve signals to the diaphragm, but even this does not cure all cases of intractable hiccups.

diaphragm

The thin muscle below the lungs and heart that separates the chest cavity from the abdomen.

When the diaphragm contracts, the lungs expand and take in air. When it relaxes, the lungs deflate and push air out.

mediastinum

The space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes.

electrolyte

A substance in the blood and other body fluids that carries an electric charge. Electrolytes are responsible for the movement of nutrients and wastes into and out of cells to keep body fluids balanced and to allow muscles to function properly.

Examples of electrolytes include calcium, chloride, potassium and sodium.

local anesthetic

A drug used to relieve pain in a small area of the body. It can be given by injection or by rubbing a cream on the area.

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