By definition, hiccups are repeated and uncontrollable contractions of the diaphragm and other respiratory muscles, which occur suddenly. These contractions shake the thorax and cause a usually high-pitched noise that comes from the glottis and vocal cords, hence the rather particular “hic” sound characteristic of hiccups.

While benign by nature, they can sometimes be a bit painful especially on inspiration.

Three are three kinds of hiccups:

• The classic hiccup that occurs when you eat too fast. It is called isolated hiccups, which manifest themselves as an isolated contraction of the respiratory muscles. This type of hiccup usually does not last more than a few minutes before disappearing as quickly as it happened.
• Acute hiccups, also called persistent hiccups, occur with repetitive contractions lasting up to 48 hours. This type of hiccup is also usually harmless.
• Chronic hiccups, lasting more than 48 hours. The severity of this type of hiccup is directly related to its cause and the disability it causes.

What causes hiccups

The origins of hiccups are not localized exclusively to the glottis, they can be digestive, thoracic, and cerebral.

Acute hiccups, the most frequent and less severe type, resolve spontaneously. Their causes are not fully identified but certain circumstances seem to favor their occurrence. For example, food or drink abuse, a drug reaction, stress, and anxiety have been associated with short-term hiccups.

The hiccups, in this case, are mild, they stop quickly and do not require medical attention.

Chronic, the more severe type of hiccups can have different causes:

• Digestive problems:  irritation of the esophagus, reflux esophagitis caused by a stomach condition (large hiatus hernia or tumor), can trigger hiccups.
• Pathologies: certain diseases of the abdominal cavity can also stimulate the diaphragm and be responsible for hiccups: an abscess under the diaphragm (subphrenic abscess) for example.
• Thoracic infections: certain infections of the pleura, the membrane surrounding the lung (pleurisy), the lung itself (pneumonia), or the pericardium, i.e. the envelope of the heart (pericarditis), can cause hiccups.
• Surgical procedures: hiccups can occur after surgical procedures due to the inflammatory reactions in the thoracic area (open-heart surgery, for example with stimulation of the pneumo-gastric nerve).
• Neurological issues: neurological causes are related to stimulation of the brain through infection, tumor, or stroke. They are more serious and require, after medical consultation, an assessment (additional examinations) and the initiation of treatment.

How to get rid of hiccups

The Valsalva maneuver

This method is named after its creator Antonio Maria Valsalva, an 18th-century Italian physician. In particular, it helps to balance the pressure inside the ears, a practice well known to diving enthusiasts. It consists of taking a deep breath and then exhale strongly, closing your mouth, and plugging your nose to prevent air from coming out. This increases air pressure in the chest and also in the middle ear.

This method also works on the vagus nerve, slows down the heart rate, and stimulates the irritated phrenic nerve, thus stopping the hiccups.

Hold your breath

To stop a hiccup episode, you can increase the level of carbon dioxide in your blood. To do this, breathe in deeply through your nose, hold your breath for a few seconds (about 5 seconds), and breathe out slowly through your mouth. Then, once the lungs are emptied, take a deep breath again and breathe out as if to extinguish a candle. This trick is the most discreet… and does not require any material.

Bring your knees to your chest

Alternatively, lie on your back and bring your knees to your chest to compress the diaphragm, the main respiratory muscle between your chest and abdomen, just below the lungs. By staying in this position for a few moments, your diaphragm should stop contracting.

Another very effective tip: ask your partner or friend to forcefully massage your back and more particularly the shoulder blades.

Put some sugar on your tongue

Letting sugar melt on your tongue will stimulate the vagus nerve, also called the pneumogastric nerve, which acts in particular on gastric secretion and on the vocal cords. Destabilized by the intake of sugar, it will then concentrate less on the diaphragm. With a little patience, the hiccups shouldn’t last after you swallow the sugar. If the hiccups persist, you can add wine vinegar or lemon juice to the sugar to achieve the desired effect.

Cover your ears

To get rid of hiccups, you can cover your ears with your index fingers for a few seconds. This works because certain nerves responsible for hiccups are connected to the ears. Another method is to pinch your nose and breathe lightly as if you were trying to unblock your ears.

Put some pressure on your eyeballs

Applying light pressure to the eyeballs with your fingertips slows down the heart rate, and in fact stimulates the phrenic nerve, located between the neck and the thorax and responsible for innervating the diaphragm.

Place ice on your nombril

To stop the spasmodic contractions, you can lie on your back and put some ice cubes around your navel, which is connected to the diaphragm and its phrenic nerve.

Drink a glass of water

Drinking a glass of water while holding your breath and leaning forward can also be helpful for some. This position will allow the diaphragm to be tightened so as not to let the carbon dioxide escape.

Bite on a lemon or try some vinegar

Biting on something bitter like lemon targets the vagus nerve that runs from the brain to the stomach. This sends signals to the brain and asks it to shift its focus from the hiccups to sharp taste instead.

This tip also works if you use vinegar or something else with a strong flavor.

Avoid certain foods and drinks

According to the NHS, spicy food, carbonated drinks, chewing gum, and alcoholic beverages are big triggers for hiccups. So if you have had a lot of hiccups lately, you should take these foods off your diet.

Stop smoking

Smoking can also be a reason for your hiccups, so you should consider quitting smoking.

Can hiccups cause other problems?

Chronic irritation of the vagus or phrenic nerve, which causes prolonged hiccups, may be a symptom of a lung infection (pneumonia) or inflammation of the lungs (pleurisy), pancreas (pancreatitis), or the membrane that surrounds the heart (pericarditis). Kidney dysfunction can also be the source of recalcitrant hiccups, as can a tumor in the path of one of the two nerves involved in the hiccup reflex arc: throat, esophagus, diaphragm, lungs.

While the hiccups themselves may be benign, these diseases on the contrary can have grave health consequences for the patient.

Hiccups can sometimes also precedes a cerebrovascular accident (CVA), but this is rare.

Last words

Hiccups result from a spasmodic contraction of the diaphragm and intercostal muscles, immediately followed by the closing of the vocal cords at the larynx. Hiccup attacks usually only last a few minutes.

But a hiccup that lasts and which, in particular, prevents sleep must be taken seriously, and lead to a precise search for its origin. Considered a disease, this chronic hiccup can therefore become very disabling (in addition to being quite unglamorous).

Fun fact: The longest hiccup is attributed to American Charles Osborne who hiccupped for 69 years without interruption. His life was not cut short, however, as he passed away in 1990 at the age of 96.