What Causes Persistent Hiccups?

Hiccups, clinically termed “singultus,” refer to involuntary, repetitive contractions of the diaphragm that produce a characteristic sound emanating from the pharynx. Occasional, brief episodes—such as one or two hiccups—are generally benign 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 to the individual patient’s clinical presentation.

What are the potential underlying causes in clinical practice? First, dietary factors—such as ingestion of cold, raw, or chilling foods and beverages. Second, neoplastic lesions that irritate the phrenic nerve (e.g., tumors compressing or infiltrating the nerve) may trigger hiccups. Third, psychological conditions—including anxiety and depression—can manifest with functional (idiopathic or psychogenic) hiccups.

How should such patients be managed? First, acupuncture is commonly employed. Second, vagal nerve stimulation techniques may be used. Third, pharmacologic therapy is indicated in selected cases. For instance, patients whose hiccups are triggered by consumption 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 vagotomy—may be considered.