Charles Osborne, an Iowa farmer, holds the world record for the longest bout of hiccups. He started hiccupping in 1922 (at rates up to 40 times a minute) and didn’t stop until shortly before his death about 68 years later.

Fortunately, hiccups such as this are rare — though almost everyone gets the hiccups sometimes. They usually disappear on their own within a few minutes, causing nothing more than mild discomfort — or a little embarrassment if the “hic” pops out at an inappropriate time. But they can be the sign of a serious problem.

ANATOMY OF A HICCUP

Hiccups are caused by an involuntary spasm of the diaphragm, the dome-shaped muscle that separates the chest from the abdomen and is largely responsible for breathing. The spasms are thought to be triggered by activation (or irritation) of the phrenic or vagus nerves, which carry signals to the brain from the diaphragm and other respiratory muscles.

Most hiccup cycles are brief. Something stimulates the nerve pathways… the diaphragm contracts… and vocal cords briefly close and open, causing the “hic” sound. Though bouts of hiccups can be uncomfortable, they become a health concern only when they’re persistent (lasting longer than 48 hours) or intractable (lasting two months or more).

WHEN TO WORRY

Persistent hiccups aren’t necessarily a serious symptom, but they do tend to occur in people with an underlying medical problem. Examples…

Metabolic or kidney disorders. These can cause abnormal levels of electrolytes (minerals that conduct electrical signals), an increase in waste products or abnormal levels of carbon dioxide in the blood, each of which can cause persistent hiccups in some people.

An irritation of nerves in the inner ear, sometimes caused by a foreign body (often a hair) that presses against the eardrum.

Gastroesophageal reflux disease (GERD). Frequent heartburn can irritate nerves in the esophagus and respiratory system, causing frequent hiccups.

An infection or tumor in the brain or spinal cord.

Anyone who has severe or frequent hiccups that don’t go away within 48 hours should see a doctor. In addition to taking a medical history and performing a physical exam (including an ear exam), the doctor will probably order blood tests to check for infection or metabolic disorders. He/she also may order a chest CT scan to look for a tumor or abnormalities affecting the diaphragm or the vagus or phrenic nerves.

PREVENTION

Hiccups often can be prevented. Best steps…

  • Don’t overeat. Excessively large meals cause the stomach to distend. It then pushes against the diaphragm and may irritate the phrenic nerves.

  • Take care of heartburn. People who treat heartburn with medications, such as omeprazole (Prilosec), often have a reduction in hiccups.

  • Drink water or juice instead of carbonated beverages. The carbon dioxide in colas, beer and other carbonated beverages can cause the stomach to expand and exert pressure on the diaphragm.

  • Manage stress. People who experience a lot of emotional stress tend to “gulp” air, some of which passes through the esophagus into the stomach, causing stomach distension. Stress reducers include deep-breathing exercises… relaxation techniques, such as meditation and yoga… and regular exercise.

    • Also helpful: Patients with chronic stress sometimes improve when they take a low-dose antidepressant at bedtime. Drugs such as imipramine (Tofranil) or amitriptyline (Elavil) can improve sleep and reduce stress, even in those without depression. Talk to your doctor if you feel chronically stressed out.

  • Drink body-temperature liquids. Any sudden change in temperature — from drinking hot or cold beverages, walking from a warm room into the cold or switching from hot to cold water in the shower — can trigger hiccups.

  • Avoid alcohol, spicy foods and tobacco. Alcohol relaxes the diaphragm and makes it more sensitive to hiccup triggers. Smoking and some foods — especially spicy foods — can irritate the nerves that control normal contractions of your diaphragm.

  • Ask about medications. A variety of prescription drugs have been used to prevent hiccups. These include nifedipine (Adalat, Procardia), used to treat high blood pressure… baclofen (Kemstro, Lioresal), a muscle relaxant… and diazepam (Valium), a sedative. Because these drugs can have significant side effects, doctors recommend them only for patients with severe hiccups who aren’t helped by other measures.

    • HOME REMEDIES

    Folklore is filled with hiccup remedies. None have been adequately studied in clinical trials, but some do appear to help, such as eating a spoonful of sugar or having someone startle you. Other remedies…

    Drink water through a straw while holding your ears closed with your fingers. This appears to interrupt the “arc” of nervous signals that travel from the diaphragm to the brain. Gargling, which activates the throat muscles, may have a similar effect.

    Take a deep breath, hold it for as long as you comfortably can, then breathe out. The respiratory muscles aren’t working when you hold your breath. This can reduce the transmission of the nerve signals that trigger hiccups.

    Breathe into a paper bag for about a minute. It increases blood levels of carbon dioxide, which seems to reduce hiccups in some people. It’s also good during periods of stress. It focuses your attention on something other than the stressful situation and can help reduce the swallowing and gulping of air.

    Try acupressure. Rest the heels of the palms on both cheekbones while placing the hands over the eyes. Massage the temples by pulling the thumbs in toward the palm. After massaging, remove the hands from the eyes and lightly press the tip of the nose with a fingertip.