How to Stop Hiccups

Nearly everyone has experienced hiccups, but what exactly are they? It used to be thought that a hiccup is just a simple muscle spasm of the diaphragm, but that was apparently disproven more than 40 years ago. Instead, hiccups involve a complex, orchestrated pattern of muscle contractions. But, why?

Hiccups might be a leftover from the womb. During fetal life, “hiccups are universally present, their incidence peaking in the third trimester…[This] suggest[s] that hiccups might represent a necessary and vital primitive reflex” that would permit in-the-womb training of the breathing muscles without choking on amniotic fluid.

In adulthood, nearly anything can trigger hiccups. Case in point: A 19-year-old woman presented with persistent hiccups. Her physical exam was normal except for an ant crawling on her eardrum. Once the ant was removed, her hiccups stopped.

There appear to be as many cures for hiccups as there are causes, as I discuss in my video How to Stop Hiccups. As the famous Dr. Mayo put it, the less we know about something, the more treatments we seem to have for it—and perhaps “there is no disease which has had more forms of treatments…than has persistent hiccups.”

There are drugs, of course. There are always lots of drugs, from thorazine to apomorphine, but there are also a whole slew of non-pharmacological approaches—from breathing into a paper bag and drinking from the far side of a glass to smearing mustard on your tummy (as you can see at 1:24 in my video). “Many of these ‘remedies’ have not been tested and some appear to have been invented ‘purely for the amusement of the patient’s friends’.” One method, “forcible traction of the tongue” (which means pulling on someone’s tongue) was attributed to the great Dr. Osler, the first Chief Physician at Johns Hopkins Hospital, but the “therapy, however, is much older and (perhaps not surprisingly) of French origin.”

Another trick that might work to cure hiccups is “a modified Heimlich maneuver,” consisting of just three thrusts and moderate pressure. In one instance, it was so successful the patient’s “hiccups ceased immediately.” In general, however, “[t]reatment is notably disappointing, as is evidenced by the hundreds of remedies have been tried, none of which have been regularly curative.” You know doctors are starting to get desperate when they suggest things like chilling the ear lobe, and you know they are really getting desperate when they have to add prayer to the end of a miscellaneous hiccup cures list.

“Use of vinegar to relieve persistent hiccups in an advanced cancer patient” was the paper that started me down the hiccup rabbit hole. I was reviewing the latest research on vinegar and stumbled across a case where, “[a]fter the failure of common treatments for hiccups, the patient was given a sip of vinegar and his hiccups abated”—stopped after just a single sip. Evidently, sour tastes, such as vinegar and lemon, have been used to treat hiccups since the 1930s, but “nonpharmacological remedies such as vinegar…fell out of favor with the widespread use of pharmacotherapy,” that is, drugs. After all, how much can you charge for a sip of vinegar?

If worse comes to worst, there is the “phrenic nerve crush” surgery, which is as bad as it sounds. Before going that route, though, you may find it “surprising how many patients with hiccups respond to digital compression of the eyeballs.” Yes, we’re talking about digit as in finger, as in pushing your finger into someone’s eyes as a counter-irritation measure. That will get their mind off their hiccups!

How to Stop Hiccups

If a finger in the eye somehow doesn’t distract them enough, doctors can try “digital rectal massage.” A 27-year-old man presented to the ER with “intractable hiccups.” Emergency staff tried massaging other places and even tried the digital eyeball compression, but nothing seemed to do it. So, bend over. “Digital rectal massage was then attempted using a slow circumferential motion”—and it worked! So, before giving patients drugs, maybe we would give them a massage. It’s “easy to perform” and may be less dangerous than sticking your fingers into people’s eye sockets, which, if you’re in medical school and have to memorize all these ridiculous names, is known as the Dagnini-Aschner Maneuver. (Medicine loves its eponyms.)

Speaking of maneuvers, how’s this for a pick-up line? “Hello. (Hic!) Want to help me (hic!) cure my hiccups?” In one case, on the fourth day of continuous hiccuping, the patient’s hiccups finally “suddenly and completely ceased,” with some spousal help, at the point of climax. “It is unclear,” the doctor wrote, “whether orgasm in women leads to a similar resolution, an issue that could be investigated further.”

And it was, back in 1845. An infamous, disturbing case report that amounted to effectively bragging about sexual assault was published in what was to be become the New England Journal of Medicine. A young, religious woman with intractable hiccups fell into the hands of a Dr. George Dexter. He first attempted the best modern medicine could offer—bloodletting—but she continued to hiccup, until he pressed his hand on her genitals for a few minutes and that apparently worked. This went on for month after month, with the doctor frequently calling in his colleagues to show them this “singular phenomena.”

Who was this guy? “Although his interaction with the young female patient would not meet today’s ethical standards”—you could say that again!—”his medical observation was valid…” Even though rectal massage and sexual stimulation may help, “this kind of recommendation is reserved for carefully selected patients!”

DO NOT drink vinegar straight. In this blog, I talked about taking a tiny sip, not full-on drinking it. If you do drink instead of sip, you can make the problem worse.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not to Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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38 comments

Chad A
Chad Anderson2 months ago

Thank you.

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heather g
heather g2 months ago

I think you enjoyed that Dr Greger. Working with one's breath works, drinking while bending forwards, etc. etc.

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Connie O
Connie O2 months ago

I have on occasion had hiccups that lasted for hours. Nothing seemed to help and they would eventually stop on their own.

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Ann B
Ann B2 months ago

OMG rectal massage--now care 2 has printed it all!!!!

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Debbi W
Debbi W2 months ago

My mother once had hiccups that lasted for hours and hours. I'm not sure what caused her to stop, but she was exhausted and in pain.

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Dr. Jan H
Dr. Jan Hill2 months ago

thanks

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Karen K
Karen K2 months ago

Hold your breath and count to 10. Then breath in without exhaling from the first count and count to 5. When done breath in some more as able and count to 5. Works pretty well.

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Mona M
Mona M2 months ago

thank you, To put on the tongue half spoon of sugar with lemon juice until it melts is the best way I found.

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David C
David C2 months ago

I hate hiccups......

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Anne M
Anne Moran2 months ago

Knew a guy years ago whose uncle had the hiccups all his life, till he died in his 70s... - I think I would have been in the looney bin after a couple of hours..

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