So, I think we have all been there. Drinking a coke, or laugh hard then…hiccup. I tend to get the hiccups when I drink a carbonated beverage through a straw. Not sure why, but that’s how it happens for me. My brother has had “severe hiccups” twice from two separate steroid shots to get over colds. The remedies are about as diverse as the cause. But hopefully here we can shed some light on the ins and outs of hiccups, and how to get rid of those pesky buggers.
The word hiccup is a nonsensical onomatopoeia, meaning it is just a word that was made to sound like the sound the action makes. The technical, or medical, term for hiccups is singultus. While singultus can also be used as a term for a death rattle (more on that in a later post), it literally translates from latin to mean “sobs”. It is possible it is used as the term for hiccups because of the sound that is made as one is gasping for air when sobbing. It is unlikely a coincidence that you end up with hiccups after a nice sob, but we’re not to causes yet.
What are hiccups? Well as far as hiccups go, this is the easy question to answer. Hiccups are simply a spasm in the diaphragm muscle. The diaphragm muscle is the muscle that usually is responsible for respiration. In the picture below you can see the diaphragm is situated below the lungs. It typically relaxes to allow air to fill the lungs, then contracts when it is time to exhale. This is normally a slow, and somewhat metered action. While you can breathe on your command, the diaphragm is an involuntary muscle.
A hiccup is when the diaphragm suddenly contracts and relaxes. This is typically a muscle spasm, not much different than any other. The “hiccup” comes from the sudden rush of air down the esophagus. The air rushes past your vocal cords making the classic “hic” sound. A single hiccup is said to last around 0.25 seconds.
According to the Mayo Clinic, causes of short term hiccups can be: drinking a carbonated beverage, drinking too much alcohol (cue drunk cartoon character hiccuping bubbles out of his “XXX” bottle), eating too much, excitement or emotional stress, sudden temperature change, or swallowing air. While these seem all benign, the list for long term hiccups (as defined as lasting longer than 48 hours) is much more serious. They are broken up into three categories: nerve damage or irritation, central nervous system disorders, and metabolic disorders and drugs. The specific causes are too numerous but are things like tumors, barbiturates, steroids, and “a hair or something else in your ear touching your eardrum”.
So, that’s what causes them, but where do they come from. Well, nobody is real sure. Hiccups are only found in mammals. They are either a leftover from evolution, or a result of it. One school of thought is they are left over from our evolution from our amphibian, pre-mammalian, days. Another prominent theory is they are strategically evolved for mammals. The purpose here would be to help the mammal breath while nursing. This theory is supported by the fact that hiccupping is most common among infants. The action of hiccupping acts to help clear air from the stomach. In this theory, a hiccup is like a self-burping mechanism.
Now, the real question we have all been asking. How do I get rid of them? Well there are as many home solutions as there are people hiccupping. Everything from holding your breath, to drinking water upside down, which is no mean feat. However, there has been no consistent evidence to really support any of these home remedies. Most of these home remedies, while different, seek to stimulate the vegus nerve. If you have severe, long lasting hiccups and seek medical help, there are a few reliable options. As far as medicine goes, most of the drugs are also used for treatment of anxiety or epilepsy. Coincidentally, most of these drugs are also, or have been, used for treatment of psychological disorders like bipolar disorder or schizophrenia. On the fringe of the medical solutions for hiccups, persistent digital rectal massage (same action as a prostate exam) has been shown to relieve the spasms.
So, you stood on your head, held your breath, got your mate to scare you, and none of it worked. But you don’t want to be the fool who goes to the emergency room for a bout of hiccups, you just want them gone. There is one at home solution that has some factual basis. The spasm of your diaphragm is caused by your phrenic nerve. The picture below shows how the phrenic nerve connects to your diaphragm.
The trick to this solution is to pinch the area around your C5 vertebrae (also shown in picture) to interrupt the conversation between the vagus nerve and the phrenic nerve. As mentioned above, most of the home remedies draw their success from the stimulation of the vagus nerve. So, what this trick does is gets between the phrenic nerve and the vagus nerve interrupting the signal to let the spasms subside. This image brings it together well.
So, next time you are having a serious fight with the hiccups, search out that C5 area and give it a pinch. Not too much though, severing the phrenic nerve will paralyze the diaphragm which is fatal without mechanical respirators. Maybe just a little massaging touch. People are constantly doing silly things to get rid of hiccups. They are always looking for the best way. The pinch of the phrenic nerve near the C5 vertebrae is the only consistent way of stopping hiccups. And Now You Know.