How to stop this annoying reflex

What is hiccups?

Hiccups, medically called singultus, are an involuntary bodily reaction caused by sudden, uncontrolled movements of the diaphragm. The diaphragm is a flat muscle that separates the chest from the abdominal cavity and plays a central role in breathing. At the same time, the glottis, an opening between the vocal cords in the larynx, closes abruptly. This interrupts the airflow to the lungs and produces the characteristic “hic” sound.

There are two main types of hiccups, distinguished by their duration. Acute hiccups start suddenly and usually stop on their own after a short time. They are generally harmless and not a cause for concern. Chronic hiccups, on the other hand, last longer than 48 hours or recur frequently. This form can significantly affect quality of life and should be evaluated by a doctor. If hiccups persist for more than a month, this is referred to as persistent singultus.

Typical symptoms of hiccups are repeated “hic” sounds caused by diaphragm contractions, and rhythmic spasms in which the diaphragm suddenly and repeatedly jerks. Affected people may also feel tightness or irritation in the chest or throat. In some cases, speech can be affected because hiccups make talking difficult. Prolonged hiccups can also lead to tiredness or general discomfort.

The most common causes: how do hiccups arise?

The causes of hiccups are varied and can differ depending on duration and frequency. Acute hiccups are often triggered by certain behaviours or external factors. Typical triggers include eating or drinking too quickly, swallowing air, carbonated drinks, alcohol, spicy foods or sudden temperature changes. Stress or strong emotions can also play a role. Chronic hiccups usually have physical or neurological causes. Gastroesophageal reflux disease (GERD) is often involved, where stomach acid flows back into the oesophagus and causes irritation.

Neurological conditions such as a stroke, multiple sclerosis or a brain injury can disrupt normal diaphragm regulation and lead to persistent hiccups. Damage or irritation to nerves such as the vagus nerve or the phrenic nerve can also trigger chronic hiccups. Tumours, cysts or foreign bodies in the neck and ear region, as well as laryngitis, can be causes. Metabolic disorders such as diabetes or electrolyte imbalances are possible reasons for long‑lasting hiccups. Certain medications, like sedatives, steroids or chemotherapy drugs, may also contribute.

Baby hiccups: what helps when a child hiccups?

Hiccups in babies are in most cases completely harmless and do not cause pain. While adults and older children often find hiccups bothersome, infants are usually largely unaffected. It is mainly the parents who worry. In babies, hiccups often stop by themselves, so waiting is often the best option. If hiccups last for hours or are accompanied by symptoms such as coughing or abdominal pain, a visit to the paediatrician is advisable.

Various measures may help relieve hiccups. Regular breaks while feeding and a burp after feeding help release air from the stomach and relax the diaphragm. Gentle massage of the tummy or the soles of the feet is often found to be helpful. Alternatively, gently lifting the knees towards the chest can apply light pressure to the diaphragm.

Blowing gently on the baby’s face is also described as useful, as this slight irritation can briefly change the breathing pattern and stop the spasms. Warmth is relaxing, so swaddling in a baby carrier, placing a warm cherry‑stone pad on the abdomen or close skin‑to‑skin contact can be supportive. If hiccups occur frequently after breastfeeding, an overly strong milk flow may be the cause. Changing the feeding position or using a nipple with a smaller hole can slow the flow and help.

Hiccups are generally neither dangerous nor distressing for babies. Different methods can be tried to improve the situation. If the hiccups do not bother the baby, intervention is often unnecessary.

Persistent hiccups: when should you see a doctor?

If hiccups last for a long time or recur repeatedly, they should not be ignored. A medical consultation to clarify the causes is recommended in such cases. In some situations, persistent hiccups may indicate an idiopathic chronic hiccup, for which no clear explanation can be found. This condition is unpleasant and can be very distressing, but it is usually harmless and can be treated with breathing and behavioural therapies. Sometimes medications that relax the muscles or act on the hiccup centre can help.

Long‑lasting hiccups can also be a symptom of a serious digestive system disease. Inflammations, growths or swellings in the oesophagus, stomach or small intestine can irritate nerves and the diaphragm and disrupt airflow. Metabolic or hormonal disorders as well as neurological diseases can also trigger hiccups.

Pay attention to certain symptoms if hiccups recur or persist for a long time. If hiccups last more than a day or occur more often than usual, see a doctor. Other warning signs are heartburn, acid regurgitation, abdominal pain, fatigue, unexplained weight loss or swelling in the neck area.

It is especially important to seek immediate medical attention if hiccups are accompanied by symptoms such as headache, dizziness, nausea, speech problems, visual disturbances or paralysis. These may indicate serious neurological problems such as a stroke and require urgent medical care. In such cases hiccups are only an additional symptom; the other complaints are usually much more pronounced.

How does a doctor diagnose hiccups?

For long‑lasting or recurrent hiccups, a medical examination is important to determine the cause. The diagnostic process starts with a detailed medical history. The doctor asks about the time of onset, the duration of the hiccups and possible triggers. This helps to rule out benign factors.

If hiccups remain unexplained, further tests are performed. These include imaging procedures such as an upper endoscopy (gastroscopy), ultrasound examinations of the organs and chest X‑rays. In addition, an ECG of the heart and, depending on the suspicion, a CT scan or MRI of the head or chest may be carried out.

Despite comprehensive diagnostics, sometimes no clear cause can be found. In these situations the doctor talks about idiopathic hiccups, where no identifiable underlying disease is present.

How to get rid of hiccups: practical tips

• Drink a glass of very cold water in small or rapid sips to stimulate the vagus nerve in the throat and relax the diaphragm. This simple home remedy often helps quickly.
• Take a deep breath, hold it and count to 20, then exhale slowly to relieve the diaphragm and relax the abdominal muscles.
• Place a paper bag over your mouth and nose and breathe slowly in and out. This method increases the carbon dioxide level in the blood, which via the brainstem influences respiratory regulation and can calm the diaphragm.
• Gently grasp your tongue with your fingers and pull it slightly forward to stimulate the vagus nerve and interrupt the hiccups.
• Distract yourself by slowly counting backwards from 100 to shift your focus and relax the diaphragm.
• Lie on your back. Draw your knees to your chest and press your hands on the floor beside your body to relax the diaphragm.
• Put an ice cube in your mouth to stimulate the vagus nerve with cold and stop the hiccups. Gargling with cold water can also help.
• Gently press on your eyelids. Close your eyes and apply gentle pressure with your fingertips to relax. Lightly tickling the neck can also help. 
• Do a headstand. Take a glass of drinking water upside down to loosen the diaphragm through the unusual body position.
• Suck a cough drop: sour, sweet or spicy — sucking stimulates the throat area and soothes the vagus nerve.
• Ask someone to startle you unexpectedly to change your focus.
• Focus on even, calm breaths to gently raise the carbon dioxide level in your blood.

Hiccups are usually harmless and disappear on their own. If they last longer or occur frequently, it may be sensible to see a doctor to rule out possible causes.