Hiccups are an annoyance that usually last just a few minutes. But sometimes they can last for hours…days…or even longer.

About 4,000 times each year, someone gets hiccups that last so long the sufferer is admitted to a hospital. In doctor-speak, hiccups that last at least two days are known as “persistent,” while those lasting more than a month are considered “intractable.”

It’s these won’t-go-away hiccups that prompted Stasia Rouse, MD, and Matthew Wodziak, MD, both of Loyola University’s department of neurology, to review the medical literature. Among their findings…

With long-lasting hiccups, an underlying medical condition is usually to blame. In one patient mentioned in the review, it was arthritis in the sternoclavicular joint (which connects the collarbone to the breastbone) that caused intractable hiccups. In another patient, the hiccups were associated with pulmonary embolisms (a life-threatening condition that occurs when blood clots become lodged in the lungs).

Other causes of persistent and intractable hiccups include brain injury, meningitis, pancreatitis, esophageal cancer and reflux disease, according to a review published in Alimentary Pharmacology and Therapeutics. Medications, including steroids, tranquilizers known as benzodiazepines and opioid painkillers, can also be the culprit.

Important: Because intractable hiccups can signal a serious medical condition, anyone with hiccups lasting more than a few days should have a complete physical evaluation.

If the underlying cause of the hiccups can be identified, then the goal should be to treat the original problem. Along with that, hiccups can be treated with medications such as the muscle relaxant baclofen (Lioresal), the nerve-pain drug gabapentin (Neurontin) and the stomach and reflux drug metoclopramide (Reglan). Researchers are also studying the use of nerve blocks within or near the phrenic nerve, which is located in the neck and plays a key role in breathing.

Doctors who encounter patients with intractable hiccups must rely on their own clinical experience and/or anecdotal evidence because there are no formal guidelines for treating the condition.

This may not sound reassuring, but you can count yourself lucky if your hiccups can’t compete with the Iowa farmer who holds the record for the longest-lasting hiccups. He reportedly hiccupped continually for 69 years and nine months, according to the Guinness Book of World Records.

And if you’ve got acute hiccups, count yourself lucky—they will last only a minute or two. To help guard against this milder version of the problem, try to avoid common triggers, which include drinking a carbonated soda or downing an oversize meal. Alcohol, stress, spices, smoking and even anxiety can also set off an episode of hiccups. As most people know, these hiccups can usually be halted by holding one’s breath…or breathing into a paper bag. Hypnosis and acupuncture have also been reported as hiccup-busting remedies.