Hiccup Totally Explained

Everything about Hiccough totally explained

A hiccup or hiccough (normally pronounced "HICK-up" ), is a spasmodic contraction of the diaphragm that typically repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the epiglottis to close, creating the "hic" noise. In medicine, it's known as synchronous diaphramatic flutter (SDF), or singultus. The term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern.
A bout of hiccups generally resolves itself without intervention, although many home remedies claim to shorten the duration, and medication is occasionally necessary.

Causes

While many cases develop spontaneously, hiccups are known to be triggered by specific events, such as eating too quickly, being hungry for long, taking a cold drink while eating a hot meal, belching, eating very hot or spicy food, laughing vigorously or coughing, drinking alcoholic beverages in excess, crying out loud (sobbing causes air to enter the stomach), some smoking situations where abnormal inhalation can occur (in tobacco or other smoke like cannabis, perhaps triggered by precursors to coughing), electrolyte imbalance, talking too long, clearing the throat, or from lack of vitamins. Hiccups may be caused by pressure to the phrenic nerve by other anatomical structures, or having the sensation that there's food in the esophagus, rarely by tumors and certain kidney disease. The American Cancer Society reports that 30% of chemotherapy patients suffer singultus as a side effect of treatment.

Phylogenetic hypothesis

Christian Straus and co-workers at the Respiratory Research Group, University of Calgary, Canada, propose that the hiccup is an evolutionary remnant of earlier amphibian respiration; amphibians such as frogs gulp air and water via a rather simple motor reflex akin to mammalian hiccuping. In support of this idea, they observe that the motor pathways that enable hiccuping form early during fetal development, before the motor pathways that enable normal lung ventilation form; thus according to recapitulation theory the hiccup is evolutionarily antecedent to advanced lung respiration. Additionally, they point out that hiccups and amphibian gulping are inhibited by elevated CO2 and can be completely stopped by the drug Baclofen (a GABAB receptor agonist), illustrating a shared physiology and evolutionary heritage. These proposals would explain why premature infants spend 2.5% of their time hiccuping, indeed they're gulping just like amphibians, as their lungs are not yet fully formed.

Amniotic/atmospheric hypothesis

Ultrasound scans have also shown that babies in-utero experience hiccups. The amniotic/atmospheric hypothesis suggests that hiccups are a muscle exercise for the respiratory system prior to birth, or that they prevent amniotic fluid from entering the lungs. The amniotic/atmospheric hypothesis holds that there are two distinct systems in the brain for controlling respiration: one that's used when the fetus is respiring amniotic fluid during its time in the womb, and another that only comes into use following birth, used for breathing air. Since amniotic fluid is much more viscous than air, a much greater effort is required from the diaphragm to inhale it. If this amniotic breathing system becomes dominant for any reason during life outside the womb, the result will be a momentary, very forceful effort at inhalation. The body senses that things are not correct, and since so much force is actually dangerous to the lungs and other organs, the system is immediately preempted and switched back to the atmospheric system. However, this preemptive control gradually relaxes, making the phenomenon cyclic as long as there's underlying activation of the amniotic respiration system: as the preemptive control falls below the threshold, the amniotic routine resumes control, only to be preempted again, and this cycle continues until the underlying conditions leading to the amniotic breathing activation revert to their normal state – at which point the hiccups stop. This theory is supported by the finding that hiccups are more common in premature newborns, as in these cases the atmospheric respiration system is less prepared to take precedence over the amniotic respiration system.

Treatment

Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them. However, there are a number of anecdotally prescribed treatments for casual cases of hiccups (see Home Remedies below). These include being startled, drinking water while upside down, eating something very sweet, or tart (particularly lemon juice), or both, and anything that interrupts one's breathing. Another method is to exhale air into a small paper bag and to immediately re-inhale that air from it. Also taking very small repeated sips of a liquid, over and over, while swallowing after each small sip can help. An average of 8-10 swallowed mini-sips, averaging one swallow a second, can help an acute case to diminish feasibly and quickly.

Medical treatment

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of a 15 year old girl 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. In severe or resistant cases, baclofen, an anti-spasmodic, is sometimes required to suppress hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating singultus is done short-term, as the affected individual can't continue with normal life activities while taking the medication.
   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.
   The administration of intranasal vinegar is thought to be safe and handy method to stimulate dorsal wall of nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (afferent of the hiccup reflex arc) is distributed.
   Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental new 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. In 2005, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression."

Home remedies

   The following are some commonly suggested home remedies. While numerous remedies are offered, they mostly fall into a few broad categories. These categories include purely psychosomatic cures centered around relaxation and distraction, cures involving swallowing and eating (with the rationale generally that this would remove irritants or reset mechanisms in the affected region), and cures involving controlled/altered breathing.
   The first two categories may prove effective for many short lived and minor cases of hiccups. For instance, with an assistant applying pressure to one's ears, drinking any quantity of liquid whilst holding one's nose is a common home remedy for hiccups. However, those suffering from an intractable case may become desperate sorting through various ineffective home remedies. Many of the cures centered around controlled breathing (for example holding breath) are often ineffective for prolonged hiccups crises, but do have a significant efficacy for the most casual, short lasting cases. For these scenarios, the underlying rationale could be the displacement of an irritated nerve through prolonged diaphragmatic expansion.
   However, one respiratory remedy has a fairly sound rationale underlying it. Breathing into a bag or small enclosed container (ensuring that it's completely sealed around the mouth and nose) induces a state that's termed respiratory acidosis. The effect is caused by increasing the amount of inspired carbon dioxide, which then increases the level of carbon dioxide in the serum. These increased levels of CO₂ lower the pH in the blood, hence creating a state of acidosis. This state of acidosis produces vasodilation and depression of the central nervous system. The effect allows for increased blood flow to the affected muscles, and suppression of the aberrant nervous impulses. Inducing a state of acidemia through hypoventilation is particularly effective in curing hiccups because the diaphragm rests directly against the pulmonary vasculature that's then flowing with especially low pH blood. This is a potentially dangerous action; and should only be done with another person present. As the serum CO₂ level rises abruptly, the person will begin to feel lightheaded and within a few minutes will pass out. If done without a spotter, the person might either injure him or herself as he or she passes out, or pass out in such a way that the bag or container continues to prevent oxygen intake (see also asphyxia).
   Additionally, another respiratory remedy appears to be one of the most effective in treating persistent hiccups. One breathes out all the air that he's able to in one long exhalation then breathes in all the air he feels he possibly can in one continuous inhalation. The person then attempts to breathe in even more air in a series of short powerful puffs, until his lungs can't hold any more. The person remains in this state for as long as he feels a small gas bubble coming at the very base of the throat, ready to be burped. Although the success rate isn't 100%, many people find this method consistently works. One scientific explanation for this method is that, by breathing an extreme load of air, the lungs tend to take more space in the chest, applying pressure on the surrounding content. The so-called gas bubble, which was located in an abnormal location potentially disturbing a nerve and causing the spasm, is then released.
Psychosomatic

Distraction from one's hiccup (for example being startled, asked a perplexing question, or counting in reverse from 100 down or reciting the alphabet in reverse.)
Concentration on one's hiccups - using sheer will to stop them
While standing and concentrating on relaxation, extend the right arm and point with the index finger at a point to your right, and exhale. While inhaling, bring the tip of the index finger to the nose, and hold the breath for a moment - then exhale, dropping the finger away from the nose.

Respiratory

Cutting air off from the esophagus. This is done by tipping one's head forward and downward as far as possible. It usually takes a minute. This usually doesn't work the first time.

Similar to above, tip your head forward and downward as far as comfortably possible and then drink from the opposite side of a cup. (You will be pouring the liquid AWAY from your body and towards your head).

"Isometric Breathing". IE: Breathing slowly and deeply in while thinking 'breathing out' and breathing slowly and fully out while thinking 'breathing in'

Holding one's breath while optionally squeezing one's stomach

Breathing deeply through the nose, then exhaling slowly through the mouth. This is also a Lamaze technique.

Exhaling all the air from one's lungs and holding one's breath while swallowing water or saliva

Blowing up a balloon

Inducing sneezing

Insert fingers in ears and hold breath for as long as possible

Take a gulp of water or liquid, hold in mouth, insert fingers in ears and swallow while fingers are still in ears. Repeat a few times.

Attempting to burp

Take a deep breath and hold it for until you feel the first pain wave, which means that your body has gotten over its hiccup, then wait for second pain wave which indicates you've run out of oxygen, and breathe out

Exhaling all the air of one's lung and holding it until one can (theoretically stops the spasm on the diaphragm).

Take a deep breath, hold it for 30 seconds then exhale as slowly as possible while making a growling sound. Other

Make out with someone. The sucking action during deep kisses stops the hiccups.

In babies, hiccups are usually immediately stopped by the suckling reflex, either by breastfeeding or simply by insertion of a finger, bottle teat or dummy into the baby's mouth.

Pinch your ear lobe and breathe normally. Can turn into second-nature (psychosomatic).

Close your eyes and look up as far as possible.

Drinking a good amount of water

Take 10 sips of water

Chew a spoonful of peanut butter slowly, or put sugar on the tongue.

Slowly swallow a spoonful of sugar.

Mix sugar into a cup of water and drink slowly

Eat a pickle.

Press tongue hard against roof of mouth.

Digital rectal massage

Plug your ears with your thumbs, and use your pinkies to plug both nostrils and hold your breath until cessation of hiccups.

Stick your tongue out for 5 seconds and then exhale and inhale and then suck on your thumb.

Long-term cases

American man Charles Osborne had the hiccups for 68 years, from 1922 to 1990, and was entered in the Guinness World Records as the man with the Longest Attack of Hiccups.
In January 2007, teenager Jennifer Mee from Florida in the United States hiccuped for five weeks, from January 23, 2007 until February 28, 2007. After her hiccups returned, however, her neurologist suggested that she may actually be suffering from Tourette Syndrome.

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