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If too much holiday merriment is giving you the hiccups, you're not alone. Everyone gets hiccups from time to time, usually as a result of irritation of the stomach or esophagus. Hiccups happen when you intake air sharply. That intake results from muscle spasms in the chest, throat, and diaphragm, the large muscle that lies between the chest and abdomen. The sudden inhalation causes a rapid closure of the glottis, the flap of tissue that normally blocks the food tube when you breathe and the air tube when you eat. The rapid passage of air through the vocal cords produces the characteristic sound of a hiccup.
But what causes those muscle spasms in the first place? The most common cause is irritation of certain nerves that regulate breathing. Too much holiday cheer may induce such irritation, as can wintertime bouts of laryngitis or treatable conditions such as a hernia. Toxic-metabolic disorders such as alcohol intoxication, uremia, and general anesthesia can cause hiccups. Psychological triggers include anxiety, stress, and excitement.
But in certain--albeit rare--instances, hiccups can persist for days, weeks, month, even years. In such cases, doctors may suspect yet another category of causation: disorders of the central nervous system (brain and spinal cord). And that leads to a fascinating case study published in the December 13 issue of Neurology. Three medical experts at the University of Maryland School of Medicine in Baltimore report treating a 44-year-old man who developed hiccups that persisted over a three-month period. The frequency of his hiccups remained nearly constant, and the hiccups often interrupted his speech.
Despite an amputation of his left leg, the man was generally very healthy. He was bright, alert, and intelligent. His visual acuity was perfect, and the movements of his eyes and pupils (which neurologists often use to detect signs of neurological impairment) were normal. All his sensory and motor functions were intact, and his blood chemistries came back from the lab marked normal.
He just couldn't stop hiccupping.
An MRI of the brain revealed the probable cause of his nonstop hiccups: a tumor of brain cells called astrocytes (see photomicrograph). Intractable hiccups caused by malignancies are exceedingly rare, and this paper is the first to report a tumor of this type as the cause.
Astrocytes in a rat brain. (Micrograph from University of Utah.)
For most of us--even those who experience long-lasting hiccups--there is no reason to suspect a cause as serious as a rare brain tumor. More than 100 possible causes for hiccups have been identified. Most of the time, hiccups simply signal a need to back away from the buffet table. In most cases, sipping water or holding one's breath provides a sufficient cure, since those actions "press the reset button" on the nerves that control breathing. (Anecdotal evidence suggests those methods work, although there is no documented proof.)
But in rare cases like the Maryland patient, drugs and medical/surgical treatments may be indicated. The Maryland doctors gave their patient an IV-infused form of the drug chlorpromazine. The man's hiccups ceased.
Oh, by the way, if your holiday hiccups get annoying for a short time, consider yourself lucky. It's claimed that the record holder for duration of hiccupping is held by American Charles Osbourne, who hiccupped continuously from 1922 to 1990. As far as we know, he never had an MRI...and maybe no drug treatment. I'm guessing that breath-holding didn't work for him either.
For More Information:
The Mayo Clinic has a good explanation (with diagram).
Megan H. Lee, Jennifer M. Pritchard, and William J. Weiner. Clinical Reasoning: A 44-year-old man with a 3-month history of hiccups. Neurology (December 13, 2011) 77(24) e145-e148.
Cartoon from Ghana Nation.
