Hiccup
Encyclopedia
A hiccup or hiccough is a myoclonus
Myoclonus
Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. It describes a medical sign and, generally, is not a diagnosis of a disease. Brief twitches are perfectly normal. The myoclonic twitches are usually caused by sudden muscle contractions; they also can result from brief...

 of the diaphragm that repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the vocal cords to close, creating a "hic" sound.

In medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 it is known as synchronous diaphragmatic flutter (SDF), or singultus, from the Latin singult, "the act of catching one's breath while sobbing". The hiccup is an involuntary action
Involuntary action
An involuntary action is one which occurs without the conscious choice of an organism. If it occurs specifically in response to a stimulus, it will be known as a reflex....

 involving a reflex arc
Reflex arc
A reflex arc is a neural pathway that controls an action reflex. In higher animals, most sensory neurons do not pass directly into the brain, but synapse in the spinal cord...

.

A bout of hiccups, in general, resolves itself without intervention, although many home remedies
Home remedy
A home remedy is a treatment to cure a disease or ailment that employs certain spices, vegetables, or other common items. Home remedies may or may not have medicinal properties that treat or cure the disease or ailment in question, as they are typically passed along by laypersons...

 are often used to attempt to shorten the duration. Medical treatment is occasionally necessary in cases of chronic hiccups.

Causes

Phylogenetic hypothesis

Researchers at the Respiratory Research Group, University of Calgary
University of Calgary
The University of Calgary is a public research university located in Calgary, Alberta, Canada. Founded in 1966 the U of C is composed of 14 faculties and more than 85 research institutes and centres.More than 25,000 undergraduate and 5,500 graduate students are currently...

, Canada, propose that the hiccup is an evolutionary remnant of earlier amphibian
Amphibian
Amphibians , are a class of vertebrate animals including animals such as toads, frogs, caecilians, and salamanders. They are characterized as non-amniote ectothermic tetrapods...

 respiration
Respiratory system
The respiratory system is the anatomical system of an organism that introduces respiratory gases to the interior and performs gas exchange. In humans and other mammals, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles...

; amphibians such as tadpoles gulp air and water across their gills via a rather simple motor reflex akin to mammal
Mammal
Mammals are members of a class of air-breathing vertebrate animals characterised by the possession of endothermy, hair, three middle ear bones, and mammary glands functional in mothers with young...

ian hiccuping. In support of this idea, they observe that the motor pathways that enable hiccuping form early during fetal
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

 development, before the motor pathways that enable normal lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

 ventilation form. Thus, according to recapitulation theory
Recapitulation theory
The theory of recapitulation, also called the biogenetic law or embryological parallelism—and often expressed as "ontogeny recapitulates phylogeny"—is a disproven hypothesis that in developing from embryo to adult, animals go through stages resembling or representing successive stages...

 (a theory that has lost much of the support it once had) the hiccup is evolution
Evolution
Evolution is any change across successive generations in the heritable characteristics of biological populations. Evolutionary processes give rise to diversity at every level of biological organisation, including species, individual organisms and molecules such as DNA and proteins.Life on Earth...

arily antecedent to modern lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

 respiration
Respiratory system
The respiratory system is the anatomical system of an organism that introduces respiratory gases to the interior and performs gas exchange. In humans and other mammals, the anatomical features of the respiratory system include airways, lungs, and the respiratory muscles...

. Additionally, they point out that hiccups and amphibian
Amphibian
Amphibians , are a class of vertebrate animals including animals such as toads, frogs, caecilians, and salamanders. They are characterized as non-amniote ectothermic tetrapods...

 gulping are inhibited by elevated CO2 and can be completely stopped by the drug Baclofen
Baclofen
Baclofen is a derivative of gamma-aminobutyric acid . It is primarily used to treat spasticity and is under investigation for the treatment of alcoholism....

 (a GABAB
GABA B receptor
GABAB receptors are metabotropic transmembrane receptors for gamma-aminobutyric acid that are linked via G-proteins to potassium channels...

 receptor
Sensory receptor
In a sensory system, a sensory receptor is a sensory nerve ending that responds to a stimulus in the internal or external environment of an organism...

 agonist
Agonist
An agonist is a chemical that binds to a receptor of a cell and triggers a response by that cell. Agonists often mimic the action of a naturally occurring substance...

), illustrating a shared physiology and evolution
Evolution
Evolution is any change across successive generations in the heritable characteristics of biological populations. Evolutionary processes give rise to diversity at every level of biological organisation, including species, individual organisms and molecules such as DNA and proteins.Life on Earth...

ary heritage. These proposals explain why premature infants
Premature birth
In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...

 spend 2.5% of their time hiccuping, indeed they are gulping just like amphibian
Amphibian
Amphibians , are a class of vertebrate animals including animals such as toads, frogs, caecilians, and salamanders. They are characterized as non-amniote ectothermic tetrapods...

s, as their lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...

s are not yet fully formed.
Fetal intrauterine hiccups are of two types. The physiological type occurs prior to twenty-eight weeks after conception and tend to last five to ten minutes. These hiccups are part of fetal development and are associated with the myelination of the Phrenic nerve (which drives the diaphragm).

Signs & symptoms

  • A single or a series of breathing diaphragm spasms, of variable spacing and duration.
  • A brief (less than one half second), unexpected, shoulder, abdomen, throat, or full body tremor.
  • Hiccups might be easily heard as a chirp, squeak, "hupp", or if properly controlled, a quick inhaling gasp, sigh, or sniff.
  • The victim might complain of brief but distracting or painful, frequent or occasional interruptions in normal breath, with sudden momentary pain of the throat, chest, or abdomen.
  • If the hiccups are properly controlled there is no discomfort except for the mild distraction of the occasional uncontrollable gasp.

Factors

  • Overeating
  • Sudden temperature changes
  • Carbonated beverages, alcohol
    Alcohol
    In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

    , dry breads, and some spicy foods.
  • Laughing
  • Tobacco
    Tobacco
    Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...

     use (nicotine
    Nicotine
    Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...

    )

Causes of persistent hiccups

  • Metabolic diseases
  • Diabetes
  • Kidney failure
  • Electrolyte imbalance
  • Deviated septum

CNS disorders

  • Stroke
  • Multiple sclerosis
  • Tumors
  • Meningitis
  • Encephalitis
  • Traumatic brain injury

Nerve damage/irritation

  • Vagus and phrenic nerve involvement
  • Laryngitis
  • Cysts
  • Goiter
  • Gastroesophageal reflux

Treatment

Numerous medical remedies exist but no particular treatment is known to be especially effective. Many drugs have been used, such as baclofen
Baclofen
Baclofen is a derivative of gamma-aminobutyric acid . It is primarily used to treat spasticity and is under investigation for the treatment of alcoholism....

, chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...

, metoclopramide
Metoclopramide
Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...

, gabapentin
Gabapentin
Gabapentin is a pharmaceutical drug, specifically a GABA analogue. It was originally developed for the treatment of epilepsy, and currently is also used to relieve neuropathic pain...

, and various proton-pump inhibitors. Hiccups that are secondary to some other cause like gastroesophageal reflux disease
Gastroesophageal reflux disease
Gastroesophageal reflux disease , gastro-oesophageal reflux disease , gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus...

 or esophageal web
Esophageal web
-Presentation:Its main symptoms are pain and difficulty in swallowing .Esophageal webs are thin membranes of normal esophageal tissue consisting of mucosa and submucosa. They can be congenital or acquired. Congenital webs commonly appear in the middle and inferior third of the esophagus, and they...

s are dealt with by treating the underlying disorder. A simple treatment involves increasing the partial pressure
Partial pressure
In a mixture of ideal gases, each gas has a partial pressure which is the pressure which the gas would have if it alone occupied the volume. The total pressure of a gas mixture is the sum of the partial pressures of each individual gas in the mixture....

 of CO2 and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag
Paper bag
A paper bag or paper sack is a preformed container made of paper, usually with an opening on one side. It can be one layer of paper or multiple layers of paper and other flexible materials. A bag is used for packaging and/or carrying items....

. Vagus nerve stimulation
Vagus nerve stimulation
Vagus nerve stimulation is an adjunctive treatment for certain types of intractable epilepsy and treatment-resistant depression.- Mechanism of action :...

 can improve hiccups, done at home by irritating the pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...

 through swallowing dry bread or crushed ice, or by applying traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....

 to the tongue, or by stimulating the gag reflex
Gag reflex
The pharyngeal reflex or gag reflex is a reflex contraction of the back of the throat, evoked by touching the soft palate or sometimes the back of the tongue. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking...

. The phrenic nerve
Phrenic nerve
The phrenic nerve originates mainly from the 4th cervical nerve, but also receives contributions from the 5th and 3rd cervical nerves in humans....

 can be blocked
Nerve block
Regional nerve blockade, or more commonly nerve block, is a general term used to refer to the injection of local anesthetic onto or near nerves for temporary control of pain. It can also be used as a diagnostic tool to identify specific nerves as pain generators...

 temporarily with injection of 0.5% procaine
Procaine
Procaine is a local anesthetic drug of the amino ester group. It is used primarily to reduce the pain of intramuscular injection of penicillin, and it was also used in dentistry. Owing to the ubiquity of the trade name Novocain, in some regions procaine is referred to generically as novocaine...

, or permanently with bilateral phrenicotomy or other forms of surgical destruction. Even this rather drastic treatment does not cure some cases, however.

In Plato
Plato
Plato , was a Classical Greek philosopher, mathematician, student of Socrates, writer of philosophical dialogues, and founder of the Academy in Athens, the first institution of higher learning in the Western world. Along with his mentor, Socrates, and his student, Aristotle, Plato helped to lay the...

's Symposium
Symposium (Plato)
The Symposium is a philosophical text by Plato dated c. 385–380 BCE. It concerns itself at one level with the genesis, purpose and nature of love....

, Aristophanes
Aristophanes
Aristophanes , son of Philippus, of the deme Cydathenaus, was a comic playwright of ancient Athens. Eleven of his forty plays survive virtually complete...

 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
Sneeze
A sneeze is a semi-autonomous, convulsive expulsion of air from the lungs through the nose and mouth, usually caused by foreign particles irritating the nasal mucosa...

. Compare this ancient recommendation with the vagal nerve stimulation techniques mentioned previously.

An anecdotal medical approach is to install lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...

 liniment 3% or gel 2% in the external ear. 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 December 23, 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 girl who, in 2007, hiccuped continuously for five weeks. Haloperidol
Haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....

 (Haldol, an anti-psychotic and sedative), metoclopramide
Metoclopramide
Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...

 (Reglan, a gastrointestinal stimulant), and chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...

 (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
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....

 imbalance (hypokalemia
Hypokalemia
Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low...

, hyponatremia
Hyponatremia
Hyponatremia is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal. In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium and is not due to sodium deficiency. Sodium is the dominant extracellular...

) 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
Vinegar
Vinegar is a liquid substance consisting mainly of acetic acid and water, the acetic acid being produced through the fermentation of ethanol by acetic acid bacteria. Commercial vinegar is produced either by fast or slow fermentation processes. Slow methods generally are used with traditional...

 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
Afferent nerve
In the nervous system, afferent neurons , carry nerve impulses from receptors or sense organs towards the central nervous system. This term can also be used to describe relative connections between structures. Afferent neurons communicate with specialized interneurons...

 of the hiccup reflex arc) is located.

Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University
Louisiana State University
Louisiana State University and Agricultural and Mechanical College, most often referred to as Louisiana State University, or LSU, is a public coeducational university located in Baton Rouge, Louisiana. The University was founded in 1853 in what is now known as Pineville, Louisiana, under the name...

 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
Electricity
Electricity is a general term encompassing a variety of phenomena resulting from the presence and flow of electric charge. These include many easily recognizable phenomena, such as lightning, static electricity, and the flow of electrical current in an electrical wire...

 to the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...

 by way of the vagus nerve
Vagus nerve
The vagus nerve , also called pneumogastric nerve or cranial nerve X, is the tenth of twelve paired cranial nerves...

, which passes through the neck. The Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

 approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

."

Society and culture

American Charles Osborne had the hiccups for 68 years, from 1922 to 1990, and was entered in the Guinness World Records
Guinness World Records
Guinness World Records, known until 2000 as The Guinness Book of Records , is a reference book published annually, containing a collection of world records, both human achievements and the extremes of the natural world...

as the man with the longest attack of hiccups.

In 2007, Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...

 teenager Jennifer Mee gained media fame for hiccuping around 50 times per minute for more than five weeks. A neurologist suggested that she may have had Tourette syndrome
Tourette syndrome
Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical tics and at least one vocal tic; these tics characteristically wax and wane...

, and the hiccups may have been "tics" caused by it, but this has been disputed. Known as "Hiccup Girl", she was arrested after a fatal robbery and accused of murder in October 2010; her attorney suggests that Tourette Syndrome may be used to defend her case.

Briton Christopher Sands had hiccups for a period of almost three years which were eventually discovered to be due to a tumor located on the part of the brain that controls vascular activity. Once 2/3 of the tumor was removed, the hiccups appeared to lessen, and Sands no longer suffers from the condition.

In Slavic and Baltic folklore, it is said that hiccups occur when the person experiencing them is being talked about by someone not present. Hiccups in Indian folklore are similarly said to occur when the person experiencing them is being thought of by somebody close.

External links

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