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Ask a Scientist: What Are Hiccups?

| April 19th, 2013
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What are Hiccups?

The Scientist: Anthony Komaroff, M.D., is a professor at Harvard Medical School, senior physician at Brigham and Women's Hospital in Boston and author of the syndicated newspaper column Ask Doctor K.

The Answer: Hiccups are almost as mysterious as they are annoying. (Almost!) They’re impossible to study in the lab because you never know when you’re going to get them and they’re usually over pretty fast, but doctors have their theories as to what’s going on. Basically, it seems that hiccups are a breathing reflex gone haywire.

Normally, when you breathe in, the muscles in between your ribs contract, pulling your ribs outward and expanding your lungs. At the same time, your diaphragm—the flat muscle that divides your chest from your abdomen—moves downward, opening up more space in your lungs. This creates a vacuum that causes you to suck in air.

When you hiccup, both of these things happen, but uncontrollably and much faster than when you’re taking a normal breath. The diaphragm spasms quickly and repeatedly, making you take a series of tiny inhalations. Meanwhile, the space between your vocal cords suddenly snaps shut, blocking the airflow and causing that trademark “hic!” sound.

Though hiccups’ exact cause remains unclear, the speculation is that the nerves involved in breathing are firing when they shouldn’t be. These nerves branch out to other areas of your body, too, like the back of your throat and your stomach, which might explain why hiccups involve both a diaphragm spasm and a throat closure. 

Everyone’s got her favorite folksy remedy for hiccups, but the ones that stimulate the back of your throat seem to be most effective. The thought is that they distract those nerves from signaling the spasms. Some options: pulling on your tongue, putting a teaspoon of granulated sugar on the back of your tongue, gargling with water, sipping ice water, drinking upside-down from the far side of a glass, biting on a lemon, tapping or rubbing the back of your neck, or changing your breath pattern by holding your breath or breathing into a paper bag. Getting startled may help, presumably because the emotional charge overrides the reflex.

There are some triggers that seem to be associated with hiccups’ onset—excitement, stress, lots of food, and smoking and alcohol, which might increase nerve sensitivity—though these vary from person to person.

Some people get chronic hiccups. They may go away for a bit, but keep coming back. It's possible that a condition is making the nerves to the diaphragm more irritable. In rare cases, chronic hiccups can be caused by a disease, like a tumor or enlarged thyroid pushing on one of your nerves, or an abscess on the liver nudging the diaphragm. For chronic hiccups that are interfering with your life, a doctor can prescribe medications that act on nerves, including chlorpromazine, haloperidol and metoclopramide, which haven’t been studied on hiccups, but are shown anecdotally to help. If you just happen to get them a lot and struggle to make them go away, unfortunately, medical science hasn’t yet figured out what’s up. In the meantime, do hold your breath.

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