Hiccups Treatment & Management

  • Author: Garry Wilkes, MBBS, FACEM; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Jul 19, 2010
 

Prehospital Care

Administer supportive care as indicated by the causative pathology (eg, oxygen for the patient whose hiccups may be secondary to pneumonia).

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Emergency Department Care

Generations of physicians have yet to discover a definitive cure for hiccups. A statement from the Mayo Clinic expressed the situation perfectly in 1932, "The amount of knowledge on any subject such as this can be considered as being in inverse proportion to the number of different treatments suggested and tried for it."

Direct therapy at the cause of the hiccups, if identified, and then to the hiccups themselves, if needed. Treatments can be divided into the categories of pharmacologic, nonpharmacologic, and other. Elements of nonpharmacologic treatments are as follows:

  • Many traditional remedies used in an ED have a sound physiological basis affecting components of the hiccup reflex.
    • Stimulation of nasopharynx - Forcible traction on the tongue, swallowing granulated sugar, gargling with water, sipping ice water, drinking from the far side of a glass, biting on a lemon, inhaling noxious agents (eg, ammonia)
    • C3-5 dermatome stimulation - Tapping or rubbing back of the neck, coolant sprays, acupuncture
    • Direct pharyngeal stimulation - Nasal or oral catheter (90% effective)
    • Direct uvular stimulation - Spoon or cotton-tip applicator
    • Removal of gastric contents - Emetics, nasogastric tube
  • Vagal stimulation (Only one technique at a time is recommended.)
    • Iced gastric lavage
    • Valsalva
    • Carotid sinus massage (only by experienced personnel after exclusion of contraindications)
    • Digital ocular globe pressure (only by experienced personnel after exclusion of contraindications)
    • Digital rectal massage
  • Interference with normal respiratory function - Breath holding, hyperventilation, gasping (ie, fright), breathing into a paper bag (increases partial pressure of carbon dioxide), pulling knees up to chest and leaning forward, continuous positive airway pressure, rebreathing 5% carbon dioxide
  • Mental distraction - For example, ask the patient to "think of a loved one remembering you." An inventive naval doctor achieved success by offering $10 if the patient could continue to hiccup immediately.
  • Other
    • Behavioral conditioning (including other members of the family unit)
    • Hypnosis
    • Acupuncture (including near-infrared irradiation of acupoints)[12, 13, 14]
    • Phrenic nerve or diaphragmatic pacing: Incidental cure during cardioversion has been reported.
    • Phrenic nerve block surgery: Surgical interruption of the phrenic nerve has been advocated for intractable cases that are unresponsive to other treatment. This final and most drastic approach may be associated with considerable morbidity and is not universally successful. Microvascular decompression of the vagus nerve has been described as a successful procedure.[15, 16]
    • Prayer: The most novel cure for one patient was to pray to the Catholic patron saint of lost causes, St. Jude. After 8 years and more than 60,000 suggested treatments, his prayer to St. Jude was answered.
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Consultations

Consultation rarely is necessary unless the etiology of hiccups requires a specialist.

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Contributor Information and Disclosures
Author

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of 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.

Acknowledgments

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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