- Author: Garry Wilkes, MBBS, FACEM; Chief Editor: Steven C Dronen, MD, FAAEM more...
A wide variety of conditions may contribute to hiccups. The possibilities are narrowed down by the findings from the history and physical examination. Laboratory testing is directed toward suspected abnormalities.
- Electrolytes - Hyponatremia can be either the cause (including Addison disease) or the effect (drinking water as a cure) of hiccups; other electrolyte-related causes are hypokalemia, hypocalcemia, and hyperglycemia
- Renal function tests - Uremia
- Liver function tests - Hepatitis
- Amylase and lipase levels - Pancreatitis
- White blood cell (WBC) count
Certain infectious diseases may cause a patient to hiccup. Appropriate testing for such infections may include the following:
- Cerebrospinal fluid (CSF)
Radiography, CT, and MRI
Imaging modalities that may be helpful in the workup include the following:
- Chest radiography to identify tumors, detect infection, or assess the thoracic aorta
- Fluoroscopy of diaphragmatic movement to confirm the diagnosis if malingering is suspected or to determine if the diaphragmatic abnormality is unilateral or bilateral before invasive therapy
- Computed tomography (CT) of the head, thorax, and abdomen to identify tumors, infection, or structural lesions
- Magnetic resonance imaging (MRI) to detect multiple sclerosis or evaluate vascular relations to the vagus and phrenic nerves
Other studies that may be helpful include the following:
- Electrocardiography to detect MI, pericarditis, or dysrhythmias
- Before invasive therapy, nerve conduction studies to confirm the diagnosis and to confirm the presence of unilateral or bilateral involvement
- Endoscopy or bronchoscopy
- Before corrective surgery, an esophageal acid perfusion test to determine if gastroesophageal reflux is a causative factor
Wang T, Wang D. Metoclopramide for patients with intractable hiccups: a multicentre, randomised, controlled pilot study. Intern Med J. 2014 Dec. 44(12a):1205-9. [Medline].
Lee GW, Kim RB, Go SI, et al. Gender differences in hiccup patients: analysis of published case reports and case-control studies. J Pain Symptom Manage. 2015 Nov 17. [Medline].
Vanamoorthy P, Kar P, Prabhakar H. Intractable hiccups as a presenting symptom of Chiari I malformation. Acta Neurochir (Wien). 2008 Nov. 150(11):1207-8; discussion 1208. [Medline].
Krysiak W, Szabowski S, Stepien M, Krzywkowska K, Krzywkowski A, Marciniak P. Hiccups as a myocardial ischemia symptom. Pol Arch Med Wewn. 2008 Mar. 118(3):148-51. [Medline].
Morinaka S. Herpes zoster laryngitis with intractable hiccups. Auris Nasus Larynx. 2009 Oct. 36(5):606-8. [Medline].
Yeatman CF 2nd, Minoshima S. F-18 fluorodeoxyglucose PET/CT findings in active hiccups. Clin Nucl Med. 2009 Mar. 34(3):197-8. [Medline].
Celik T, Kose S, Bugan B, Iyisoy A, Akgun V, Cingoz F. Hiccup as a result of late lead perforation: report of two cases and review of the literature. Europace. 2009 Jul. 11(7):963-5. [Medline].
Zugel NP, Kox M, Lang RA, Huttl TP. Laparoscopic resection of an intradiaphragmatic bronchogenic cyst. JSLS. 2008 Jul-Sep. 12(3):318-20. [Medline].
Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage. 2009 Sep. 38(3):460-5. [Medline].
Salanitri S, Goncalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J. 2009 Jan-Feb. 29(1):72-6. [Medline].
Doshi H, Vaidyalingam R, Buchan K. Atrial pacing wires: an uncommon cause of postoperative hiccups. Br J Hosp Med (Lond). 2008 Sep. 69(9):534. [Medline].
Uldum B, Hallonsten AL, Poulsen S. Midazolam conscious sedation in a large Danish municipal dental service for children and adolescents. Int J Paediatr Dent. 2008 Jul. 18(4):256-61. [Medline].
Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev. 2013 Jan 31. 1:CD008768. [Medline].
Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015 Nov. 42 (9):1037-50. [Medline].
Moretti R, Torre P, Antonello RM, Ukmar M, Cazzato G, Bava A. Gabapentin as a drug therapy of intractable hiccup because of vascular lesion: a three-year follow up. Neurologist. 2004 Mar. 10(2):102-6. [Medline].
Ong AM, Tan CS, Foo MW, Kee TY. Gabapentin for intractable hiccups in a patient undergoing peritoneal dialysis. Perit Dial Int. 2008 Nov-Dec. 28(6):667-8. [Medline].
Marinella MA. Diagnosis and management of hiccups in the patient with advanced cancer. J Support Oncol. 2009 Jul-Aug. 7(4):122-7, 130. [Medline].
Turkyilmaz A, Eroglu A. Use of baclofen in the treatment of esophageal stent-related hiccups. Ann Thorac Surg. 2008 Jan. 85(1):328-30. [Medline].
Neuhaus T, Ko YD, Stier S. Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer. 2012 Nov. 20(11):3009-11. [Medline].
Chang CC, Chang ST, Lin JC, Li TY, Chiang SL, Tsai KC. Resolution of intractable hiccups after near-infrared irradiation of relevant acupoints. Am J Med Sci. Aug 2006. 332(2):93-6. [Medline].
Chang CC, Chang YC, Chang ST, et al. Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors. Scand J Gastroenterol. 2008. 43(5):538-44. [Medline].
Dietzel J, Grundling M, Pavlovic D, Usichenko TI. Acupuncture for persistent postoperative hiccup. Anaesthesia. 2008 Sep. 63(9):1021-2. [Medline].
Choi TY, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. 2012 Dec. 20(6):447-55. [Medline].
Farin A, Chakrabarti I, Giannotta SL, Vaynman S, Samudrala S. Microvascular decompression for intractable singultus: technical case report. Neurosurgery. 2008 May. 62(5):E1180-1; discussion E1181. [Medline].
Johnson DL. Intractable hiccups: treatment by microvascular decompression of the vagus nerve. Case Report. J Neurosurg. 1993 May. 78(5):813-6. [Medline].
Naro A, Bramanti P, Calabro RS. Successful use of tetrabenazine in a patient with intractable hiccups after stroke. Pharmacotherapy. 2014 Dec. 34 (12):e345-8. [Medline].
Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and baclofen for the treatment of intractable hiccups. Pharmacotherapy. 2014 Jan. 34 (1):e4-8. [Medline].