What Causes Persistent Hiccups?

Hiccups, clinically termed “singultus,” refer to involuntary, repetitive contractions of the diaphragm that produce a characteristic sound emanating from the throat. Occasional, brief episodes—such as one or two hiccups—are generally harmless and typically resolve spontaneously within minutes. However, persistent or intractable hiccups can significantly impair quality of life and may even lead to insomnia; in such cases, management must be tailored according to the individual patient’s clinical presentation.

What are the underlying causes of hiccups in clinical practice? First, dietary factors—such as consumption of cold, raw, or chilled foods—may trigger hiccups. Second, certain neoplastic conditions may irritate the phrenic nerve, thereby inducing singultus. Third, psychological factors—including anxiety or depression—can lead to functional (idiopathic) hiccups mediated by autonomic nervous system dysregulation.

How should such patients be managed? First, acupuncture may be employed. Second, vagal stimulation techniques—such as carotid sinus massage or the Valsalva maneuver—can be effective. Third, pharmacologic therapy is indicated in selected cases. For instance, patients whose hiccups are triggered by ingestion of cold or raw foods may benefit from oral administration of ginger–brown sugar decoction. In refractory cases, surgical interventions—including vagus nerve stimulation or selective vagotomy—may be considered.