• GERD

What Causes Hiccups? And Effective Tips to Get Rid of Them

Medically reviewed and edited by Samantha Wannos, FNP-C

Everyone has experienced hiccups — those sudden, unexpected spasms that can strike at the most inconvenient times. 

Whether you're mid-conversation or trying to fall asleep, hiccups have a way of grabbing your attention.

In this article, we'll explore common triggers, possible underlying causes, and effective ways to stop hiccups.

What are Hiccups?

Singultus — more commonly known as the hiccups — is a condition caused by the abnormal contraction or spasm of the diaphragm and uncontrollable opening and closing of the voice box. 

Normally, the diaphragm — a dome-shaped muscle in the chest — contracts to allow air to flow into the lungs. This contraction becomes involuntary during hiccups, causing air to rush in unexpectedly. When the glottis snaps shut it produces the familiar “hic” sound.

What are the Different Types of Hiccups?

Hiccups are usually brief, their duration can occur occasionally for a few hours or — in rare cases — persist consistently for years. In most cases, longer episodes are linked to more serious underlying health conditions.

Transient hiccups (short-term hiccups)

This is the most common type of hiccups, lasting anywhere between a few minutes to 48 hours. It can be caused by minor irritations or temporary triggers. Transient hiccups usually resolve on their own without the need for medical intervention.

Persistent hiccups (or protracted hiccups) 

These episodes last longer than 48 hours but less than a month. They might indicate a more significant issue, such as irritation of the diaphragm or nerve-related concerns. Be sure to speak with a healthcare provider if you have hiccups that last longer than 48 hours.

Intractable hiccups

Intractable hiccups are the most severe form of them. They can persist for over a month  — sometimes lasting for years. In rare cases, they can affect the central nervous system and cause chronic medical conditions or metabolic disorders. 

One of the longest recorded cases of intractable hiccups lasted for over 60 years. The most common causes of hiccups that last for years are a complication in the gastrointestinal system.

What Causes Hiccups?

The exact cause of hiccups can vary in each person. Hiccups occur when there is irritation in the phrenic nerve. The phrenic nerve controls the diaphragm. Within the brain and spinal cord, the vagus and phrenic nerves form the hiccup reflex.

This reflex occurs automatically in the body similar to how you'd instinctively pull your hand away from a hot surface without first thinking about it.

Common hiccup triggers

Hiccups occur naturally in babies and young children. However, health experts don’t know exactly why. These episodes tend to be harmless and resolve on their own. 

Baby hiccups are common during feedings if a baby swallows air while nursing or drinking from a bottle. 

In adults, short episodes of hiccups are generally not a cause for concern and typically disappear within a few minutes. They are usually triggered by several factors, including:

• The stomach overfilling with air, fluid, or food

• Mixing the consumption of hot and cold foods and beverages

• Excessive alcohol consumption or smoking

• Emotional triggers like stress, anxiety, or excitement

Underlying Conditions That Cause Hiccups

Most hiccup episodes are brief and typically resolve on their own without any treatment. 

However — the longer the duration of hiccups — the more likely they are linked to a more serious underlying medical condition. Be sure to see a healthcare professional if your hiccups last for more than two days.

Persistent hiccups lasting over two days, recurring frequently, or significantly impacting your quality of life may require medical attention.

Nerve irritation

The phrenic nerve sends signals to the diaphragm when to contract with each breath a person makes. When this nerve gets irritated, it can sometimes cause hiccups. 

Irritation can happen anywhere along its path from the neck to the diaphragm and may result from issues like surgery or tumors. In such cases, hiccups are a symptom of a larger concern. Damage to the phrenic nerve can cause breathing issues.

GERD and acid reflux

Gastroesophageal reflux (GERD) is a condition that causes stomach acid and partially digested food to flow back into the esophagus. This can irritate the esophageal lining and cause the diaphragm to contract — triggering the hiccup reflex. 

In some cases, this irritation can lead to prolonged hiccups, especially if the reflux occurs frequently. 

If you experience GERD, consuming spicy foods, drinking carbonated beverages, and other triggers can worsen your symptoms — increasing the chances of hiccup episodes.

Central nervous system (brain and spinal cord) disorders

The brain and spinal cord make up the central nervous system (CNS). This part of the body is essential for controlling the hiccup reflex. Any condition that affects parts of the CNS can lead to hiccups. 

Health conditions where you may experience hiccups as a symptom include:

• Stroke

• Multiple sclerosis (MS)

• Traumatic brain injury (TBI)

• Encephalitis (inflammation in the brain)

• Meningitis (inflammation of the membranes surrounding the brain and spinal cord)

• Brain tumors

• Parkinson's disease (PD)

Medications that cause hiccups

Certain medications can trigger or worsen transient or persistent hiccups. These drugs can affect the nervous system or other body processes that can alter the hiccup reflex.

Drugs that stimulate the central nervous system or irritate the diaphragm can provoke hiccups, while others may interfere with normal nerve signals, leading to prolonged hiccup episodes.

Common medications that may cause hiccups include:

• Benzodiazepines, such as Xanax (alprazolam) and Valium (diazepam)  

• Barbiturates  

• Steroids, such as Neofordex (dexamethasone)  

• Chemotherapy drugs  

• Aldomet (methyldopa)

If you think your medications might be causing or worsening hiccups, talk to a healthcare provider about possible adjustments or alternative treatments to help manage symptoms.

Other factors that can cause hiccups

Below are some lesser-known factors that can lead to hiccups.

Psychological factors

Psychological factors connected to how you feel can also cause hiccups such as:

• Excitement

• Hyperventilation (often experienced during panic attacks)

• Stress

Surgical factors

Many risk factors that come with any type of surgical procedure. During surgery, the following may cause hiccups:

• Intubation: A healthcare provider places a tube down your throat to keep the airways open.

• Neck stretching: Some healthcare professionals may suggest stretching exercises to improve flexibility in the neck after surgery.

• Gastric distension: A buildup of fluid or gas in the stomach that causes bloating

Although surgeons try to prevent this from happening during surgery, pulling on internal organs during surgery can cause hiccups. This is usually due to stimulation of the vagus or phrenic nerves.

How Do You Treat Hiccups?

Treating hiccups — especially persistent or prolonged ones that keep returning — can be challenging. While most cases resolve on their own, recurrent hiccups may need specific treatment to manage discomfort and address any underlying issues.

Home remedies or therapies

There are things you can do at home to get rid of or prevent hiccups including:

• Drinking cold water: Continuing to ingest liquids stimulates the vagus nerve, which can interrupt the signals in the hiccup reflex, helping to stop hiccups.

• Breathing into a paper bag: Rebreathing carbon dioxide into a paper bag may relax the diaphragm and stop the spasms causing hiccups.  

• Swallowing sugar or honey: Granulated sugar can stimulate the vagus nerve — similar to cold water — which may disrupt the hiccup reflex.  

• Limiting alcohol or fizzy drinks: This reduces the chance of feeling bloated or as if your stomach is full of air. Feeling too full is a common trigger for hiccups. 

• Abstaining from chewing gum or smoking: This prevents swallowing too much air, which can lead to hiccups.  

• Avoiding spicy food: This will help prevent irritation of the esophagus that may trigger the hiccup reflex.  

• Eating slowly: Eating slowly reduces your chances of swallowing air from eating too fast.

• Do not mix hot and cold food: Don't eat something cold immediately after you've eaten something hot and vice versa.

Medical treatments for hiccups

Vagus nerve stimulation techniques

These methods can help manage hiccups by stimulating the vagus nerve, which can interrupt the hiccup reflex. Some of these techniques are also used to treat heart arrhythmia (irregular heartbeat). 

• Carotid sinus massage: This technique involves massaging the area of the neck over the carotid artery to stimulate the vagus nerve. However, it is no longer recommended due to the risk of stroke. It is best to not perform a carotid sinus massage without medical supervision. 

• Valsalva maneuver: This involves exhaling slowly through a closed mouth and nose, which can stimulate the vagus nerve.  

• Cold water submersion: Splashing your face with cold water can stimulate the vagus nerve, helping to stop hiccups.

Medications to treat persistent hiccups

For persistent or intractable hiccups that don't respond to simple home remedies, certain medications may be prescribed including:  

• Thorazine (chlorpromazine): This is the only antipsychotic drug that has been FDA-approved for treating intractable hiccups.  

• Haldol (haloperidol): Often used for mental health conditions, this can be effective in managing persistent hiccups.  

• Baclofen: A muscle relaxant that may be prescribed to alleviate severe, prolonged hiccups.  

• Reglan (metoclopramide): Sometimes used to treat hiccups associated with gastric issues.

Treating Underlying Diseases That Cause Hiccups

Before considering medication for your hiccups, you should consult a healthcare professional to rule out any underlying conditions that may be causing your hiccups. Addressing the root cause is often the best way to stop them. 

If GERD is the underlying cause of your hiccups, taking medications like omeprazole (Losec) can help you manage this condition and decrease your hiccup episodes.

Where Can You Learn More About Managing Hiccups?

If dealing with distressing hiccups, LifeMD can connect you with a licensed healthcare provider who can provide tips on managing them, prescribe medications, and create a treatment plan that works for you.

Make an online appointment today.

Samantha Wannos, FNP-C

Samantha has 10 years of critical care experience and approximately six years of internal medicine experience. She is skilled in helping patients manage a multitude of chronic health conditions. In her free time, Samantha enjoys spending time with her husband and children, going boating, and attending concerts.

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