Intractable Singultus: Hiccups That Won’t Go Away

Intractable singultus is the official name for persistent hiccups. Everyone experiences hiccups on occasion, including unborn children. They typically disappear fairly quickly, often within a few minutes, but may last up to a day or 2. However, certain underlying medical conditions can cause persistent hiccups. Intractable singultus is diagnosed when hiccups last longer than 48 hours.

What is a Hiccup?

illustration of human diaphramA hiccup is a respiratory reflex caused by an involuntary contraction of the diaphragm (a muscle just below the lungs) followed by a brief and fast closure of the vocal cords. Acute (the garden variety) hiccups have quite a few causes, including swallowing air, eating spicy food, drinking carbonated beverages, or even being startled.

Persistent Hiccups

The definition of intractable singultus is hiccups lasting longer than 48 hours. Persistent hiccups usually don’t exceed a month. However, there are some people who experience them for a longer period of time, or they recur frequently. The Guinness World Record holder for persistent hiccups is Charles Osborne. He had hiccups for 68 years!

When hiccups last longer than 2 days, a medical condition is the most likely source of the problem. There are more than 100 causes for intractable hiccups.  A few of the more common ones include:

  • Damage to a brain or neck nerve
  • Tumors, especially in the neck, chest, or central nervous system
  • Diabetes
  • Alcoholism
  • Bowel diseases
  • Surgery
  • Kidney failure

It is estimated that 82% of all cases of intractable hiccups occur in men. Overall, 80% of the causes are due to a physical issue. The rest are believed to stem from emotional or mental stress, such as anxiety and stress.

Diagnosis and Treatment

Patient getting an MRIIf a patient suffers from hiccups for 48 hours or longer, a complete medical workup is required. Laboratory tests for electrolytes, liver, kidney, pancreas, white blood count, and infections are done. Some additional tests that may be used for diagnosis include an ear exam, chest X-rays, diaphragm fluoroscopy, CT scan from the head to the abdomen, and an MRI.

There is no cure for hiccups, either acute or persistent. A person may be able to prevent acute hiccups by avoiding the triggers mentioned earlier, but that is not the case with intractable singultus. Since persistent hiccups are often due to an underlying medical condition, treatment of that illness may reduce or eliminate them.

There are other treatments available as well. Medications, such as Thorazine (chlorpromazine), Reglan (metoclopramide), and Lioresal (baclofen) are often used. Chlorpromazine is the preferred prescription for intractable hiccups. Additional medicinal treatments include a nerve block injection to the phrenic nerve, anticonvulsants, and benzodiazepines.

Prescription medications aren’t the only option. Stimulation of the vagus nerve has provided relief for some. This is accomplished by carotid sinus massage, digital rectal massage, the Valsalva maneuver, and/or digital ocular globe pressure.

breathing-in-paper-bagInterfering with normal breathing patterns is another therapy. Some of these techniques include breath holding, breathing into a paper bag, and bringing the knees up to the chest while leaning forward.

Additional treatments such as hypnosis, acupuncture, and meditation or prayer have proven beneficial. As a last resort, surgery may be used. Phrenic nerve ablation and microvascular decompression of the vagus nerve have been employed with success. There is even a case report that suggests sexual intercourse as a potential treatment for intractable singultus.

Nutritional Alternatives

Since there is no cure, people may wish to concentrate on the underlying medical and emotional conditions that cause both acute and persistent hiccups. There are high quality supplements available that support diabetes, the kidneys and stress.

While many people may find it funny when they, or someone they’re with, develop acute hiccups at an inopportune moment, persistent hiccups are no laughing matter. Over time they may lead to depression, weight loss due to a change in eating habits, fatigue, and sleep deprivation. If you believe your hiccups may have an underlying cause, feel free to contact one of our health advisors at DR Vitamin Solutions. Your health is our top priority.

By Greg Benic, DR Vitamin Solutions