History

No medical training is required to diagnose hiccups. For brief episodes that self-terminate or that respond to simple maneuvers, no investigation or follow-up care is necessary. In contrast, persistent and intractable hiccups frequently are associated with an underlying pathological process and may induce significant morbidity. The focus of the history, examination, and investigation is on identifying these causes and effects. A full systemic inquiry, surgical history, and comprehensive drug history may identify one of the many possible causes.

Hiccups that abate with sleep and temporally relate to stressful circumstances commonly are psychogenic in origin. Arrhythmia-induced syncope has been reported as both the cause and the effect of hiccups.^[17] Gastroesophageal reflux also may either cause or result from hiccups. Weight loss, insomnia, and emotional distress may complicate prolonged episodes. Alcoholism and acute alcohol ingestion may contribute to the development of hiccups.

Physical Examination

In view of the wide range of differentials, a full physical examination is necessary. A complete and focused physical examination may yield evidence of the following:

Head (including ears, eyes, and the entire scalp) – Foreign body or aberrant hair adjacent to tympanic membrane; glaucoma
Mouth - Pharyngitis
Neck – Inflammation (including laryngitis); mass lesions; goiter; voice abnormalities (recurrent laryngeal nerve); stiffness (possibly indicating tumors or infection)
Chest – Tumors; pneumonia; asthma
Cardiovascular system – Arrhythmias; myocardial infarction (MI); pericarditis; unequal pulses ( thoracic aortic aneurysm)
Abdomen – Gastric atony (succussion splash); organomegaly; subphrenic abscess; cholecystitis; appendicitis; abdominal aortic aneurysm (AAA); pancreatitis; peritonitis
Rectum – Mass lesions
Nervous system – Focal lesions; disordered higher mental function; indications of multiple sclerosis

Differential Diagnoses

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