There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Intractable Hiccups
The management of intractable hiccups is a complex process that involves various treatment options, including pharmacological agents and lifestyle changes.
- Treatment is often based on experience and anecdotal evidence, as there are no formal guidelines for the treatment of intractable hiccups 1.
- A number of pharmacologic options have been found to be useful, including dopamine-blocking medication, baclofen, and gabapentin, along with anticonvulsants 1.
- Baclofen and gabapentin are less likely than standard neuroleptic agents to cause side effects during long-term therapy and may be considered as first-line therapy for persistent and intractable hiccups 2.
- Other pharmacological agents that may provide benefit include metoclopramide and chlorpromazine, although the evidence for these agents is limited 2.
- Combination therapy, such as the use of baclofen and olanzapine, may also be effective in treating intractable hiccups, although strong evidence for a specific treatment regimen is lacking 3.
Treatment Approaches
- Treatment of intractable hiccups should be directed at the underlying cause whenever possible 4, 5.
- Lifestyle changes, physical maneuvers, and pharmacotherapy are common treatment modalities, with surgical intervention rarely considered 5.
- A detailed history and thorough physical examination may provide clues for the etiology of the hiccups, and terminating an episode of hiccups can greatly improve the patient's quality of life 5.
Underlying Causes
- Intractable hiccups can be caused by various underlying conditions, including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary, and gastrointestinal etiologies 4.
- Persistent or intractable hiccups can be a harbinger of serious medical pathology, and a thorough evaluation is necessary to determine the underlying cause 5.