What are hiccups and why do we get them?

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Dear Cecil: One day, in response to a case of the munchies, I started scarfing forkfuls of cold macaroni and cheese from a dish in the fridge. I soon gave myself a case of hiccups, which I proceeded to douse with a drink of milk. This got me to thinking: what are hiccups? Do they have a role in how our bodies function? Why does rich food (even macaroni and cheese) cause hiccups? Why does drinking cure hiccups? And, paradoxically, why does drinking (of alcohol) also cause hiccups? Daniel J. Drazen, via the Internet


Illustration by Slug Signorino

Cecil replies:

You’re lucky to be writing me now, Dan. For years very little was known about hiccups and even less was written about them. Today that’s changed. We still don’t know jack, but scientists have explained this to us at length.

Here’s what we know. When you hiccup, your diaphragm and nearby muscles convulse, causing you to briefly gulp air. Within 35 milliseconds the glottis (the opening at the top of the air passage) slams shut, producing the characteristic “hic.”

If you’re able to stifle the hiccup right away, great. But if you hiccup more than seven times you’d better settle in for the long haul. Once in hiccup mode you typically will hiccup 63 times or more. Maybe a lot more. The hiccup record, last time I checked, was 57 years.

Hiccups are commonly caused by distention of the stomach, which you get if you eat too much, drink carbonated beverages, or swallow too much air. This suggests hiccup as a sequela to boozing may be more the result of fizzy mixers than alcohol itself. Or else you just slurp.

Lots of other things can cause hiccups too, some of them pretty scary. Skimming through a long list, I see skull fracture, epilepsy, diabetes mellitus, myocardial infarction, tuberculosis, meningitis, bowel obstruction, and ulcerative colitis.

But it’s not always, or even usually, so bad. A 27-year-old man complained that he’d been hiccuping for four days. The doctor looked into the guy’s ear and saw a hair tickling the eardrum. The hair having been washed out, the hiccups stopped.

Why do we hiccup? I don’t know, and as far as I can tell, neither does anyone else. Unlike gagging, sneezing, etc., hiccups serve no known useful function. Some speculate that hiccups “may represent a vestigial remnant of a primitive reflex whose functional or behavioral significance is now lost,” as one researcher put it.

Or maybe they’re just, you know, hiccups — an accidental reflex triggered by a stimulus to (usually) the vagus or phrenic nerves. This travels up the line to a nerve control center that for some reason sends out a “commence hiccup” impulse via the phrenic nerve.

The vagus and phrenic nerves go all over, which explains why so many things cause hiccups. For example, a 16-year-old girl began hiccuping after receiving a blow to the jaw. A brain scan found that a blood vessel was pressing against the vagus nerve in her neck. Surgeons inserted a Teflon spacer between the nerve and the blood vessel, and the hiccuping stopped. When the spacer later fell out the hiccuping resumed.

Which brings us to the question of hiccup cures, of which a great many have been proposed. Unfortunately, to paraphrase the distinguished physician Charles Mayo, the number of remedies is in inverse proportion to the likelihood that any one of them will actually work.

Home remedies are mostly based on the idea that you have to disrupt the hiccup cycle. These include holding your breath, induced sneezing, breathing into a bag, drinking water while covering your ears, pulling your tongue, pressing on the eyeballs, sudden fright, or — this is interesting — eating dry granulated sugar. Merely drinking water, if done soon enough, may work by washing down a glob of food in your throat that’s pressing against a nerve.

If the preceding are unavailing, a doctor may try drugs such as chlorpromazine, tickling the pharynx with a catheter stuck through the nose, hypnosis, or acupuncture. Still no go? Time for stern measures. In 1833 it was recommended that you blister or burn the skin above the phrenic nerve on the neck and back. This has now been supplanted by a marginally more civilized procedure in which the nerve is sliced or crushed.

Sometimes unorthodox procedures are efficacious. Doctors tried everything they could think of on a 60-year-old man who’d been hiccuping for two days. No luck, so “digital rectal massage was performed, resulting in abrupt cessation of the hiccups.” I’ll bet.

If that’s not your cup of tea, the case of a 32-year-old man with persistent hiccups offers hope. His hiccups stopped when he had sex. But it was only temporary, and additional therapy was soon required. The obvious question to have put to this guy: you sure you want this cured?

Cecil Adams

Send questions to Cecil via cecil@straightdope.com.