Hiccups 

  • Author: Garry Wilkes, MBBS, FACEM; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Apr 4, 2012
 

Background

The term "hiccup" derives from the sound of the event. "Hiccough" erroneously implies an association with respiratory reflexes. The medical term, singultus, is thought to have originated from the Latin, singult, which translates roughly as "the act of catching one's breath while sobbing."

Brief episodes of hiccups, which often induce annoyance in patients and merriment in observers, are a common part of life. Prolonged attacks are a more serious phenomenon and often 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. If hiccups last longer than 48 hours, they are considered persistent or protracted. Hiccups lasting longer than one month are termed intractable. The longest recorded attack is 6 decades.

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Pathophysiology

Hiccups appear to serve no purpose in humans or other mammals. Often, only one hemidiaphragm is affected. The left hemidiaphragm is affected in 80% of cases, although bilateral involvement may occur.

Hiccups occur 4-60 times per minute until a certain number has been delivered. Typically, this is fewer than 4 or more than 30. The frequency is relatively constant for a given individual and varies inversely with arterial PCO2. Loudness and rapidity of hiccups are unrelated. Hiccups are more common in the evening and may continue for a few waking hours. Hiccups occur most frequently during the first half of the menstrual cycle, especially in the few days before menstruation, and decrease markedly during pregnancy.

The exact cause remains a mystery despite centuries of contemplation. Hippocrates and Celsus associated hiccups with liver inflammation and other conditions. Galen believed hiccups were due to violent emotions arousing the stomach.

In 1833, Shortt first recognized an association between hiccups and phrenic nerve irritation.

The hiccup reflex, originally proposed by Bailey in 1943, consists of the following:

  • Afferent limb - Phrenic and vagus nerves and sympathetic chain arising from T6-12
  • Hiccup center - Nonspecific location between C3 and C5
  • Connections to the respiratory center, phrenic nerve nuclei, medullary reticular formation, and hypothalamus
  • Efferents
    • Phrenic nerve (C3-5)
    • Anterior scalene muscles (C5-7)
    • External intercostals (T1-11)
    • Glottis (recurrent laryngeal component of vagus)
    • Inhibitory autonomic processes
    • Decreasing esophageal contraction tone
    • Lower esophageal sphincter tone
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Epidemiology

Sex

Overall incidence of hiccups is equal between males and females; however, protracted and intractable hiccups occur more frequently in men (82% of cases).

Age

Hiccups occur at any age and in utero. Preterm infants spend up to 2.5% of their time hiccupping. 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.

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Contributor Information and Disclosures
Author

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Brief episodes of hiccups are typically of little impact and often merely a source of amusement. In contrast, persistent and intractable can be of enormous impact, impairing all aspects of daily life. My thanks to those who have shared their stories including success or otherwise.

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