What are the measures for treating hiccups (synchronous diaphragmatic contractions)?

From the Guidelines

For hiccups, breathing control methods, such as moderate or deep-inspiration breath-hold, should be tried first as they can help reduce respiratory tumour motion and may interrupt the hiccup reflex. These techniques, as described in the study 1, include controlled breathing methods like active-breathing control, self-held breath-hold without respiratory monitoring, and self-held breath-hold with respiratory monitoring. Some key points to consider when using breathing control methods for hiccups include:

• Moderate or deep-inspiration breath-hold can significantly reduce respiratory motion and change internal anatomy in a way that protects critical normal tissues, as noted in the study 1.
• Active breathing control enables reproducible breath-hold and can be used to help manage hiccups.
• Self-held breath-hold with or without respiratory monitoring can also be effective in interrupting the hiccup reflex. It is essential to note that if hiccups persist, medical treatment may be necessary, and medications like baclofen, chlorpromazine, metoclopramide, or gabapentin may be considered. However, based on the most recent and highest quality study available 1, breathing control methods should be the first line of treatment for hiccups. Additionally, addressing any underlying medical conditions and avoiding trigger foods and beverages can help prevent hiccups. Some key takeaways for managing hiccups include:
• Staying hydrated
• Avoiding carbonated beverages, alcohol, and spicy foods
• Trying breathing control methods first
• Considering medical treatment if hiccups persist beyond 48 hours.

From the FDA Drug Label

Intractable Hiccups– 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated.

The recommended measures for intractable hiccups are:

• Dosage: 25 mg to 50 mg
• Frequency: t.i.d. (three times a day) or q.i.d. (four times a day)
• Alternative therapy: If symptoms persist for 2 to 3 days, parenteral therapy is indicated 2

From the Research

Measures for Hiccups

• Hiccups can be treated with various methods, including lifestyle changes, physical maneuvers, pharmacotherapy, and surgical intervention 3
• The treatment of hiccups should be directed at the underlying cause whenever possible 3, 4
• For persistent and intractable hiccups, pharmacological agents such as baclofen, gabapentin, metoclopramide, and chlorpromazine may be effective 5, 4, 6
• Baclofen and gabapentin are less likely to cause side effects during long-term therapy and may be considered as first-line therapy for persistent and intractable hiccups 4
• There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions 7

Pharmacological Treatments

• Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 5
• Other pharmacological treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 5
• Dopamine-blocking medications, anticonvulsants, and other therapy have also been reported to be successful for intractable hiccups 6

Non-Pharmacological Treatments

• Physical maneuvers and lifestyle changes may be effective in terminating acute hiccups 3
• Acupuncture techniques have been studied as a potential treatment for persistent and intractable hiccups, but the evidence is limited and of poor quality 7