From the Guidelines
To treat hiccups, breathing techniques that reduce vagal tone and sympathetic activity, such as diaphragmatic breathing, may be beneficial. This approach is supported by a recent study on abdominophrenic dyssynergia, which suggests that reducing vagal tone and sympathetic activity can help alleviate symptoms related to diaphragmatic dysfunction 1.
Treatment Options
- Diaphragmatic breathing: This technique involves slow, deep breathing exercises that can help reduce vagal tone and sympathetic activity, potentially alleviating hiccup symptoms.
- Other home remedies: Simple remedies like drinking a glass of cold water quickly, holding your breath for 10-20 seconds, or breathing into a paper bag for a few minutes may also be effective in stopping hiccups.
Underlying Mechanism
Hiccups occur when the diaphragm contracts involuntarily, followed by sudden closure of the vocal cords, producing the characteristic "hic" sound. Reducing diaphragmatic spasms or affecting the nerves involved in the hiccup reflex can help alleviate symptoms.
Medical Treatment
If hiccups persist for more than 48 hours, medical treatment may be necessary. However, the provided evidence does not specifically address medical treatment for hiccups, and therefore, diaphragmatic breathing and other non-pharmacological interventions should be prioritized due to their safety and potential efficacy 1.
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 treatment for intractable hiccups is chlorpromazine (PO) 25 mg to 50 mg t.i.d. or q.i.d. If symptoms persist for 2 to 3 days, parenteral therapy is indicated 2.
From the Research
Treatment Options for Hiccups
- Pharmacologic interventions:
- Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups 3
- Other pharmacologic treatments that have been proposed for intractable and persistent hiccups include amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid 3
- Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials 3
- Non-pharmacological interventions:
- Acupuncture techniques have been studied for the treatment of persistent and intractable hiccups, but all four studies had a high risk of bias and did not compare the intervention with placebo 4
- There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions 4
Specific Treatments
- Baclofen: has been suggested as a possible treatment for chronic hiccup in cancer patients 5
- Proton pump inhibitors (PPIs): may be used as first-line therapy for persistent hiccups, especially if the cause is suspected to be gastroesophageal reflux disease (GERD) 6