How to Stop Hiccups

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“[N]early everybody has experienced hiccups…” But, what exactly are they? The idea that a hiccup is just a simple muscle spasm of the diaphragm was apparently disproved over 40 years ago. Instead, it involves a complex orchestrated pattern of muscle contractions. But, why?

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

In adulthood, nearly anything can trigger hiccups. Case in point: “19-year-old woman…with persistent hiccups.” “Physical exam was normal,” except there was an ant crawling on her eardrum. The ant was removed, and the hiccups stopped. And, there appear to be as many cures as there are causes. As the famous Dr. Mayo put it, the less we know about something, the more treatments we seem to have for it. And, perhaps “no disease…had more forms of treatment than [the] persistent hiccup.”

There’s drugs, of course; there’s always lots of drugs, from thorazine to apomorphine. But, there’s 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 onto your tummy. You’ll note “[m]any of these quote-unquote ‘remedies’ have not been tested and some appear to have been invented ‘purely for the amusement of the patient’s friends.'”

This first one here, 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. But, the therapy dates back earlier, to “(perhaps not surprisingly)…French origin[s].”

Another trick that might work is “a modified Heimlich maneuver, with [just] moderate pressure.” “Three thrusts,” and the hiccups were gone. In general, though, treatments are disappointing. “[H]undreds of remedies have been tried, but none have been found to be “regularly curative.” You know doctors are getting desperate when they start suggesting things like chilling of the earlobe, and you know doctors are really getting desperate when they have to tack onto the end: “Prayer.”

This is the paper that started me down the hiccup rabbit hole. I was reviewing the latest research on vinegar, and stumbled across this. “After the failure of common treatments for hiccups, the patient was given a sip of vinegar,” and his hiccups stopped after just a single sip. Sour tastes, such as vinegar and lemon, have evidently been used to treat hiccups since the 1930s, but “nonpharmacological remedies such as vinegar…fell out of favor with the widespread use of [drugs].” After all, how much can you charge for a sip of vinegar?

Worse comes to worst, there’s surgery—the “phrenic nerve crush,” which is as bad as it sounds. But, before you go down that route, you’d be surprised “how many patients with hiccups respond to digital compression of the eyeballs.” Digit as in finger, as in, like, pushing your thumbs into someone’s eyeballs as a counter-irritation measure. That’ll get their mind off of their hiccups. And, if that doesn’t distract them enough, there’s always “digital rectal massage.”

27-year-old man presents to the ER with “intractable hiccups.” They try massaging other places. They try the “digital eyeball compression.” Nothing really seems to do it, so, bend over. “Digital rectal massage was then attempted using a slow circumferential motion”—and it worked! So, before giving people drugs, maybe we would be giving patients 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 stupid names, is known as the “Dagnini-Aschner Maneuver” (medicine loves its eponyms).

Speaking of maneuvers, how’s this for a pick-up line? Hey, *hic,* wanna help me cure my hiccups? “On the fourth day of continuous hiccupping,” with spousal help, the patient’s hiccups vanished at the point of climax. “It is unclear,” the doctor wrote, “whether orgasm in women leads to a similar resolution, an issue,” he said, would have to “be investigated further.”  

And it was, back in 1845, in an infamous, disturbing case report amounting to effectively bragging about sexual assault, published in what was to become the New England Journal of Medicine. A young religious woman with intractable hiccups fell into the hands of a Dr. George Dexter, who first attempted the best modern medicine could offer—bloodletting. She still hiccupped, though, until he pressed his hand on her genitals for a few minutes, and it apparently worked. This went on for month after month, frequently calling upon his colleagues to “[exhibit] to 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 [considered] valid.”

Though “[r]ectal massage and sexual stimulation [may] help,…this kind of recommendation [should probably be] reserved,” this research review continues, he concluded, “for carefully selected patients.”

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Image credit: Illia Uriadnikov via 123rf. Image has been modified.

• alternative medicine
• ear health
• eye health
• hiccups
• lemons
• massage
• surgery
• vinegar