Dear Lucy: I am an 18-year-old female who has a history of asthma. So — and this may sound crazy —I have had this super weird case of the hiccups for the past seven months or so, and they don’t go away. Every day since about September, I have hiccupped more than once; and even before then, I still got hiccups, just not as frequently. Sometimes, I seem to hiccup every hour at the same time or, just about every five minutes, like a clock. I did some online research to see what this may mean, but pretty much all my search results ended with alcohol addiction or cancer. I don’t drink, and I kind of doubt I have cancer. Do you have any ideas about what it might be? —Déjà vu All Over Again
Dear Déjà: Lucy commends you for calmly seeking an answer and not allowing your online search results to induce panic. But she can certainly appreciate how annoying this problem must be and would like to help you find an answer. To that end, she brought your question to MIT Medical gastroenterologist Richard Gardner.
“Hiccups are inappropriate, uncontrollable spasms or contractions of the muscular diaphragm separating the lung cavity and the abdominal cavity,” Gardner explains. But, while he notes that asthma has been associated with increased frequency of hiccups, he would consider your daily hiccups to be cause for some concern. “When hiccups are present daily for more than one month, they are referred to as ‘intractable,’” he says, “and one should be seen by a physician for evaluation and possible treatment.”
As you undoubtedly discovered through your web searches, many different ailments may cause intractable hiccups. According to Gardner, these include conditions that result in irritation or stimulation of the vagus nerve, which innervates the upper GI tract, and phrenic nerve, which innervates the diaphragm. “Anything that creates pressure on the diaphragm can also result in hiccups,” he notes. Hiccups may be caused by conditions ranging from acid reflux or lung inflammations to chronic kidney failure (uremia), low blood electrolytes, or low blood carbon dioxide (alkalosis).
Additionally, Gardner tells Lucy that a colleague once mentioned that the presence of a foreign body in the ear canal, such as hair or other debris, might sometimes be associated with intractable hiccups. For that reason, he recommends an otoscopic exam of the ear canals if no other cause is found.
There are a variety of treatments for hiccups. Depending on the likely cause, a clinician might tell you to breathe into a bag (which increases carbon dioxide in the blood), hold your breath entirely, perform the Valsalva maneuver (which involves trying to exhale as if blowing up a balloon while closing your mouth and pinching your nose shut), sip or gargle cold water, or lean forward to decrease pressure on the diaphragm. You might also be prescribed certain medications, such as gabapentin, baclofen, or metoclopramide.
But the first step to getting rid of those annoying hiccups for good is to find out what’s causing them in the first place. And to do that, both Gardner and Lucy recommend making an appointment with your primary care provider (PCP) straightaway. It might take more than one visit or clinician or test to get to the bottom of things, but after seven months of daily hiccups, it’s way past time to start looking for some answers. —Lucy