HICCUPS: CAUSES, EVOLUTION, TYPES, HOME REMEDIES AND TREATMENT USING MEDICATIONS OR SURGERY

OVERVIEW

 Hiccups is a reflex action caused when the diaphragm suddenly and involuntarily contracts. It is also known as Singultus and is thought to have originated in mammals (especially babies) as a means of coordinating breathing and suckling of milk. Short term hiccups (that lasts for a few minutes) can be caused by excessive laughter, eating, drinking of alcohol and carbonated drinks, intense emotions etc. While long term hiccups (that lasts for hours, days or even months) can be caused by some underlying medical conditions such as nerve damage or irritation, Central Nervous System disorders, metabolic disorders and the use of certain drugs. Treatment of long term hiccups involve taking drugs such as chlorpromazine, baclofen, gabapentin etc and carrying out Phrenic nerve surgery. Home remedies used to treat short term hiccups include: taking large gulps of water, holding your breathe and counting slowly, gently placing pressure on your nose while swallowing etc.

Hiccups - that embarrassing moment!

CAUSE/EVOLUTION

Hiccups occur when the diaphragm suddenly and involuntarily contracts (tightens). This contraction is then followed immediately (about 0.25seconds later) with the closure of the vocal cords, resulting in the characteristic “hic” sound that is heard during hiccups. It is also known as Singultus (a latin word that means “Catching one’s breathe while sobbing”)

Hiccups are a reflex action (i.e. they occur pretty fast and you have no control over it) and are suggested to have evolved in mammals as a means of coordinating suckling milk and breathing. This suggestion arose from the fact that hiccups are only found in mammals, occurring mostly in babies and diminishing as they grow older. They probably allow air that is trapped in the stomach of suckling babies to escape, allowing more milk to be ingested.

• This is what actually happens during hiccups

TYPES

In most cases, hiccups are short termed (lasts for only few minutes). But in rare cases, it could be persistent (lasting for more than 48hours) or intractable (lasting even longer than a month)

Notable causes of short termed hiccups are: 

• Rapid or excessive eating

•       Intense emotions such as excitement, anxiety, or fear

•       Excessive drinking of alcohols and carbonated drinks

•       Sudden temperature changes

• ·     Excessive laughter

Long termed hiccups (i.e. the persistent or intractable hiccups) are caused by some underlying medical conditions. For better understanding, these conditions are divided into the following categories:

Nerve damage or irritation: 

This is the most common cause of long termed hiccups. Its causes are:

·        - Sore throat

·        - Gastroesophageal reflux

·        - Goitre, cyst, or tumour in the neck

·        - a hair or something else in the ear touching the eardrum

Central nervous system disorders: 

When there is a problem with the CNS, such as the presence of a tumour, infection, or injury, the ability to control the hiccups reflex could be disrupted. Examples of these CNS issues include:

·        - Tumours

·        - Meningitis

·        - Stroke

·        - Multiple sclerosis

·        - Traumatic brain injury

·        - Encephalitis

      Metabolic disorders and drugs: 

Long term hiccups can also be caused by:

- Diabetes

- Kidney failure

- Electrolyte imbalance

- Coughing

- Alcoholism

- Barbiturates

- Steroids

- Tranquilizers

TREATMENT/HOME REMEDIES

Most times, bouts of hiccups go away on their own without any medical treatment. Also, home remedies can also be used to treat it. Most of the home remedies focus on increasing the level of CO₂ in the blood, which usually stops the hiccups. Some of these remedies include:

·        - Holding your breathe and counting slowly

·        - Repeatedly breathing into a paper-bag for some time

·        - Gently placing pressure on your nose while swallowing

·        - Taking large gulps of water (especially cold water)

·        - Eating a teaspoon of sugar or honey

·        - Pulling your knees up to your chest

However, if the hiccups are persistent or intractable, underlying health issues mill most likely be the cause. Treatment measures aimed at these health issues will help relieve the hiccups. They include:

Medications: 

Drugs used to treat long term hiccups are:

·        - Chlorpromazine: This is an anti-psychotic drug that is usually used as the first-line medication

·        - Metoclopramide: an anti-nausea drug

·        - Baclofen: a muscle relaxant

·        - Haloperiodol

·        - Gabapentin

Phrenic nerve surgery (the nerve that controls the diaphragm): 

This is usually the last resort and is performed in only cases that do not respond to other treatments. It involves surgically blocking the phrenic nerve

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