Chronic Hiccups: Causes, Diagnosis, Treatment, Complications and Outlook

Updated: September 28, 2019

The unintentional movements of the diaphragm followed by rapid closure of the vocal cords that persist for an extended period of time is called as chronic hiccups.
Hiccups happen when your diaphragm contracts involuntarily. This is also known as a spasm. The diaphragm is a muscle that is located between your chest and your abdomen which helps you breathe. Your vocal cords will rapidly shut after the involuntary contraction, causing the sound that comes with the hiccups. Hiccups often develop for no apparent reason and typically go away on their own after a couple minutes. Usually it last a few minutes or hours. These are not a medical concern. However, if it last longer than two days, they are considered chronic or persistent. Chronic hiccups can last for years in some people and are usually a sign of a medical issue. They can also cause health issues themselves. When they keep you awake most nights, you may experience exhaustion.
As they can affect your appetite or desire to eat, chronic hiccups can also lead to severe weight loss. Affected people may become exhausted, dehydrated and lose weight due to interruptions in sleep and normal eating patterns. Other complications may include irregular heart beat and gastroesophageal reflux. Chronic hiccups happens more often in men than in women. But these are very rare. Other people who may have a higher risk of getting chronic hiccups include those who:

• have recently undergone general anesthesia
• experience anxiety or other mental health issues
• have had surgery in the area of the abdomen
• have illnesses of the bowel, stomach, or diaphragm
• taking certain medications
• have central nervous system (brain and spinal cord) abnormalities
• are pregnant
• have cancer
• drink alcohol excessively

The exact underlying cause is often unknown, but excitement, stress, or consuming specific food or drinks, such as fizzy soda, may trigger them. Treatment of chronic hiccups varies but may include medications and/or surgery.   

Causes of chronic hiccups:

Although the exact underlying cause of chronic hiccups is often unknown, many factors can contribute to the development of hiccups. These include hot or spicy foods and liquids, harmful fumes, surgery, or certain medications. Chronic hiccups can also be associated with a variety of health problems including:

• Pneumonia, pleurisy and other conditions that irritate the diaphragm
• Brain abnormalities such as strokes, tumors, injuries, infections
• Metabolic disorders
• Gastrointestinal (esophagus, stomach, small/large intestines) diseases
• Psychological problems such as hysteria, shock, fear, and personality disorders
• Liver abnormalities

Any medical or health issue that affects the autonomous nervous system which controls your body's unconscious actions, like breathing are related to chronic hiccups. Chronic hiccups are not inherited. Most of the cases occur sporadically in people with no family history of the condition.

Diagnosis of chronic hiccups:

A diagnosis of chronic hiccups is usually based on symptoms. However, a complete physical exam with various laboratory tests and imaging studies such as chest X-ray, CT scan, MRI scan, or fluoroscopy of the diaphragm may be performed to determine the underlying cause.

Treatment of chronic hiccups:

Most of the treatment for chronic hiccups require the help of a medical professional as it can cause health issues and can also be a sign of a larger health concern. Treatment for chronic hiccups often varies based on the underlying cause. In many cases, medications can be prescribed to treat chronic hiccups.
These may include:

• Tranquilizers such as chlorpromazine and haloperidol
• Muscle relaxants
• Anticonvulsant agents including phenytoin, valproic acid, and carbamazepine
• Sedatives
• Pain medications
• Stimulants

Many a times treating the the underlying cause can help. These may include:

• treating the health condition that is causing the hiccups
• taking medications prescribed by a doctor, such as baclofen, chlorpromazine, or metoclopramide (Reglan)
• having surgery
• electrically stimulating the vagus nerve through an implanted device
• injecting the phrenic nerve with anesthetic
• acupuncture
• Surgery can be done in some cases to temporarily or permanently block the phrenic nerve. The phrenic nerve controls the diaphragm.

Complications of chronic hiccups:

Chronic hiccups can cause gastroesophageal reflux, where stomach acid leaks up into the food pipe. This can lead to the following symptoms:

• heartburn
• an unpleasant taste in the mouth
• pain when swallowing
• bloating
• feeling sick
• bad breath
• Other complications include:
• Irregular heartbeat
• Exhaustion
• Dehydration
• Weight loss

Chronic hiccups can make it difficult to sleep or cause someone to wake up during the night. This lack of sleep can result in a lack of energy during the day, causing exhaustion if the condition persists for a long time.
Hiccuping can make it difficult to eat and drink, which can result in a lack of energy, dehydration, malnutrition, or weight loss. There is always a possibility of choking on food or drink.

Outlook of chronic hiccups:

While occasional hiccups are common and resolve quickly, chronic hiccups are very rare and more difficult to treat. It is advisable to see a medical professional if you have hiccups that last more than two days, as they could be a symptom of a serious medical condition. Chronic hiccups are unpleasant and can have a significant impact on quality of life of a person. Living with the condition can be very stressful, causing anxiety and disrupting normal routines. Therefore try to maintain good mental and physical health.
It is important to get plenty of rest, eat and drink small amounts regularly and be aware of possible complications to help cope with the condition. Taking medication that are effective in treating chronic hiccups could be beneficial.
Getting plenty of rest and taking a nap during the day if possible can help prevent exhaustion. Regular exercise is important for a healthful lifestyle. But people should avoid activities that could be too tiring.
It may be beneficial to eat smaller amounts of food throughout the day rather than eating larger meals at regular times.
People should avoid hot, spicy foods and fizzy drinks as they can make hiccups worse. Keeping a bottle of water on hand and drinking small amounts regularly throughout the day can help ensure a person stays hydrated.
Taking small mouthfuls and chewing food thoroughly before swallowing can help prevent choking on food or drink.