Hiccup - Treatment

Treatment

Numerous medical remedies exist but no particular treatment is known to be especially effective. Many drugs have been used, such as baclofen, chlorpromazine, metoclopramide, gabapentin, and various proton-pump inhibitors. Hiccups that are secondary to some other cause like gastroesophageal reflux disease or esophageal webs are dealt with by treating the underlying disorder. A simple treatment involves increasing the partial pressure of CO₂ and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag. Vagus nerve stimulation can improve hiccups, done at home by irritating the pharynx through swallowing dry bread or crushed ice, or by applying traction to the tongue, or by stimulating the gag reflex. The phrenic nerve can be blocked temporarily with injection of 0.5% procaine, or permanently with bilateral phrenicotomy or other forms of surgical destruction. Even this rather drastic treatment does not cure some cases, however.

In Plato's Symposium, Aristophanes has a case of the hiccups and is advised by Eryximachus, a physician, to cure them by holding his breath, or, failing that, by gargling or provoking sneezing. This ancient recommendation can be compared with the vagus nerve stimulation techniques mentioned previously.

An anecdotal medical approach is to install lidocaine liniment 3% or gel 2% into the ear canal. Somehow this creates a vagus nerve-triggering reflex through its extensions to the external ear and tympanus (ear drum). The effect can be immediate, and also have lasting effect after the lidocaine effect expires after about two hours.

A solution involving sugar placed on or under the tongue was cited in the 23 December 1971 issue of the New England Journal of Medicine.

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of Jennifer Mee, a 19-year-old woman who, in 2007, hiccuped continuously for five weeks. Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating with sedatives is only appropriate short-term, as the affected individual cannot continue with normal life activities while under their effect.

Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to normalize the potassium–sodium balance in the nervous system. The carbonation promotes quicker absorption. Carbonated beverages, including beer, by themselves may provoke hiccups in some people.

The administration of intranasal vinegar was found to ease the chronic and severe hiccups of a three-year old Japanese girl. Vinegar may stimulate the dorsal wall of the nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (the afferent of the hiccup reflex arc) is located.

Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy."

Lockhart stated that hiccups can sometimes be cured by pinching the skin that covers the surface of the deltoid muscles, thus pinching the phrenic nerve branch located there.