Hiccups (or hiccoughs), medical term singultus (rarely used), are an unpleasant phenomenon, experienced by everyone on occasion, and usually self-limiting. However the much rarer intractable chronic form can be extremely debilitating.
Hiccups are a symptom that has probably been experienced by everyone at some point in their lives. Chronic intractable hiccups are rare.
Acute hiccups are those lasting less than 48 hours, and are usually self-limiting.
Chronic, persistent hiccups refers to any episode with a duration greater than 48 hours. Intractable hiccups, sometimes defined as those lasting more than two months, can be very disabling, causing inability to sleep, depression, and chronic exhaustion, with secondary deleterious effects on an individual's health.
Curiously for such a common, everyday phenomenon, the direct cause and pathogenesis of this symptom remains unknown.
The currently accepted hypothesis is that hiccups occur secondary to dysfunction of the swallowing reflex arc, of which there are three main components 1:
- central processor
- efferent limb
Neurotransmitters implicated include GABA and dopamine.
- sudden/marked gastric distension e.g. large meal, carbonated beverages
- psychogenic factors
More than 100 causes have been identified 1:
- diabetes mellitus
- electrolyte disturbances e.g. hyponatremia, hypokalemia, hypocapnia
- ethanol excess
- benzodiazepines e.g. diazepam
- steroids e.g. dexamethasone
The features of the underlying causes are described in their respective articles.
Treatment and prognosis
Folk remedies abound for the treatment of acute hiccups.
Initially therapy is directed to the specific cause.
In addition for the more serious chronic intractable form there are pharmacological and non-pharmacological interventions.
History and etymology
Singultus is the Latin for sobbing, gasping.
- 1. Eisenächer A, Spiske J. Persistent hiccups (singultus) as the presenting symptom of medullary cavernoma. (2011) Deutsches Arzteblatt international. 108 (48): 822-6. doi:10.3238/arztebl.2011.0822 - Pubmed
- 2. Abubaker AK, Rabadi DK, Kassab M, Al-Qudah MA. Persistent Hiccups After Cervical Epidural Steroid Injection. (2018) The American journal of case reports. 19: 397-399. Pubmed