How to treat hiccups

Hiccups can be extremely annoying, and when they last for hours or days, torture. So what are some strategies to treat them?

In a 2015 systematic review of pharmacologic therapy for persistent/intractable hiccups in 341 patients in 15 studies, Steger et al noted that treatment of the underlying condition was the most successful, but there were no high-quality data to allow for pharmacologic treatment recommendations.

Pharmalogical agents:

  1. Chlorpromazine (Compazine): drug of choice in many situations.
  2. Baclofen: can be used in patients with renal impairment
  3. Gabapentin: possibly more effective in patients with CNS lesions
  4. Metaclopramide (Reglan)
  5. HaldolL reported effective in doses 2-5 mg IV
  6. Lidocaine: there is very limited evidence, such as small case series in cancer patients
  7. Ketamine: again, very limited evidence
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2 thoughts on “How to treat hiccups

  1. Spasm of the thoracoabdominal diaphragm, also known as singultus, can also be treated with OMM (osteopathic manipulative medicine), using Reflex-Oriented treatment. The Diaphragm is innervated by the Phrenic nerve (C3, C4, C5), which runs anteriorly/diagonally across the anterior scalene muscle. With the patient in the supine or seated position, locate the triangle formed by the sternal and clavicular heads of the left sternocleidomastoid muscle (the patient can turn their head slightly to the right to help expose the area). Using the thumb, index, or middle finger, press deep into this triangle (thus, pressing on the phrenic nerve in an attempt to inhibit the signal). This pressure should elicit a mild degree of discomfort (to tolerance) and be maintained for at least a minute after the hiccups cease to break the reflex arc. If the technique is unsuccessful on the left, it may be repeated on the right.

    Osteopathic visceral techniques are defined in the glossary of osteopathic terminology by the Educational Council on Osteopathic Principles (ECOP) as “a system of diagnosis and treatment directed to the viscera to improve physiologic function; typically the viscera are moved toward their fascial attachments to a point of fascial balance; also called ventral techniques”.

    Reflex-oriented techniques (which falls under the umbrella of visceral techniques) attempt to produce a secondary reaction in an organ system by affecting the autonomic nervous system (usually sympathetic but sometimes parasympathetic). This is similar to using other autonomic reflexes, such as carotid massage, vagal induction through Valsalva maneuver, ocular pressure, ice water immersion, and so on. These treatments are in areas that can affect the autonomic nervous system in specific ways associated with either sympathetic or parasympathetic reactivity. They are an attempt either to increase or to decrease the levels of autonomic output at the area in question.

    References
    1. Ward R. Foundations for Osteopathic Medicine. Philadelphia, PA: Lippincott Williams & Wilkins, 2003.
    2. Barral JP, Mercier P. Visceral Manipulation.Seattle, WA: Eastland, 1988.
    3. Agur AMR, Dalley AF. Grant’s Atlas of Anatomy. 11th ed. Baltimore: Lippincott Williams & Wilkins, 2005.

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