Hiccups are a reaction of our body as special as it is familiar. We almost all have is experiencing one or more episodes of hiccups at some point in our lives and we have tried the most varied actions to try to put an end to it. In the medical field, the technical word for hiccups is “singulto”, a term which comes from the Latin “singultus” and which can mean “to gasp”, “sigh” or “to sob”.
Hiccups are caused by sudden, involuntary, repeated contractions of the diaphragm – the dome-shaped muscle that separates the chest cavity from the abdominal cavity – causing rapid entry of air into the lungs and, after that, its blockage due to the sudden closure of the glottis – a space located in the larynx, where the vocal cords are located. All of this triggers the typical hiccup sound we’re used to. For unknown reasons, hiccups affect significantly more men than women.
These contractions of the diaphragm during hiccups are triggered by the (usually transient) alteration in the functioning of the vagus or phrenic nerves that control the contraction and relaxation of this muscle or the respiratory center (located in the medulla oblongata, under the brain). to exist several factors which increase the risk of hiccups: excess food, consumption of alcohol, tobacco or carbonated drinks, sudden changes in ambient temperature, emotional stress, excessive swallowing of air (aerophagia)…
But where does the hiccups come from?
Although the factors favoring the appearance of hiccups are well identified, the mechanism involved is generally unknown in almost all cases. What causes the nerves that reach the diaphragm to suddenly send abnormal signals temporarily? It’s a mystery in almost every case. There is also no known utility or necessary function of hiccups in the human body. Unlike other involuntary reflexes like coughing or sneezing, which have obvious protective functions, it seems that hiccups happen for no reason that justifies it.
Hiccup attacks are almost always just another incident in our lives and they usually last a few minutes. However, sometimes the hiccups can last for weeks, months, years or even almost a lifetime. The most extreme case of hiccups is that of Charles Osborne (1894-1991), who holds the Guinness World Record for his longest duration: 68 years of uninterrupted hiccups, with an average frequency of 40 episodes per minute.
When the singulto persists for this long, it is likely to be a sign of a disease, especially if there are other symptoms or warning signs (mainly neurological) that indicate that something is wrong in the human body. Among the conditions that can rarely cause hiccups – nearly a hundred have been documented – include gastroesophageal reflux disease, pneumonia, inflammation of the pericardium (pericarditis), alcoholism, tumors or heart attacks that affect the medulla oblongata. Besides, abdominal or thoracic surgeries however, the consumption of certain medications can predispose to an attack of hiccups.
Is there a proven method to stop a hiccup attack?
Home remedies for hiccups abound in popular culture and on the internet. to exist multitude of techniques which are directed in most cases to cause changes in the activity of the nerves which reach the diaphragm or the glottis. These include holding your breath for 15-20 seconds or breathing into a bag (to increase the concentration of CO₂ in your blood), sucking on a lemon, doing the Heimlich maneuver, pulling your knees towards your chest and lean forward, giving the person with hiccups a fright or drinking water for a long time.
However, no clinical trial has been able to assess the real effectiveness of these “treatments” and everything surrounding these maneuvers is either anecdotal evidence or at best has very limited scientific support from studies with a small number of cases. The reason is simple: hiccups are usually a sudden event and temporary, which stops by itself after a few minutes. It is therefore difficult to rigorously study the usefulness of the different methods precisely because of these characteristics. Moreover, in these cases, the hiccups are practically a curiosity and there is little medical interest in the allocation of resources to investigate this matter.
The situation is very different for persistent hiccups, which last from days to years. There, the singulto can seriously affect the quality of life. Either because it makes it difficult or prevents the accomplishment of various jobs or tasks of daily life or because it ends up causing psychological discomfort (anxiety and stress) to the person who suffers from it. In cases where hiccups are caused by an illness, treatment will aim to treat it.
No studies on the horizon
So far, no scientific study has been able to demonstrate the clear effectiveness of any particular drug or intervention to treat hiccups.
Sometimes it is not possible to identify a reason concrete after a quack that does not stop. When this happens, doctors may resort to various medications such as muscle relaxants, antiepileptics, anticonvulsants or antipsychotics. If the hiccups persist after using the above medications, there are more invasive procedures to block the repetitive contraction of the diaphragm: applying a nerve conduction blocker (such as procaine) to the phrenic nerve to inactivate it or implanting a vagus nerve stimulation device. In the most extreme cases, surgical cuts were made of the two phrenic nerves, a drastic procedure which does not, however, guarantee a cure in all patients.
No scientific study to date has been able to demonstrate the clear effectiveness of any particular medication or intervention to treat this hiccup. In 2013, a Cochrane systematic review stated the following: “Our conclusion is that there is insufficient evidence to recommend any particular treatment for hiccups. Randomized controlled studies are needed to identify treatments that might be effective or harmful in the treatment of persistent hiccups.” ” .
