What Are Hiccups?
Hiccups are caused by uncontrollable, repetitive contractions of the diaphragm, the structure of muscle below your lungs that controls your breathing. With each hiccup, your diaphragm contracts out of sync with your normal breath, and the resulting rush of air suddenly into your lungs makes the typical ‘sound of a hiccup’. Each spasm of the diaphragm forces your larynx (voice box) and vocal cords to suddenly close. This forced and rapid expulsion of air, charged with various gases from oxygen to sulphur, comes out of the lungs so fast that it can cause the glottis (entrance to the lungs) to slam shut, too [1, 2].
What are the Causes of Hiccups?
Many factors can set off hiccups. These include:
- Overeating
- Eating spicy foods
- Drinking alcohol
- Drinking beverages with carbonation
- Eating super-hot or ice-cold foods
- Sudden change in the air temperature
- Swallowing too much air
- Emotional stress [1].
Some lifestyle characteristics also put you at increased risk for getting the hiccups: you’re more likely to hiccup if you’re male, have a strong emotional or mental response to something, have had surgery, particularly stomach or abdominal surgery, or have received general anaesthesia [1].
Other diseases and disorders can also trigger hiccups, such as:
- Stroke
- Meningitis
- Tumours
- Head trauma
- Multiple sclerosis
- Gastrointestinal reflux
- Gastritis
- Peptic ulcer disease
- Pancreatitis
- Gallbladder issues
- Pneumonia
- Pulmonary embolism
- Heart attack [3, 4].
Medications might pose a triggering factor as well. Steroids, tranquillisers, barbiturates, anaesthetics, and certain antibiotics are all linked with hiccups [2,3]. Sometimes, hiccups may be a symptom of underlying grave conditions such as myocardial ischaemia and sarcoidosis [6].
Risk Factors of Hiccups
There are also risk factors for hiccups based on gender and age. Men are much more likely to get hiccups than women [7, 8]. Also, advancing age is a risk factor for hiccups, especially and exclusively in men [8].
Conversely, low serum sodium levels – which results in a severe condition known as hyponatremia – are associated with a higher risk of hiccups. Specifically, patients with normal serum sodium have a 2.5% risk of hiccups, whereas those with serum sodium levels that fall below average by 10 mEq/L were 17 times more likely to hiccup [9].
In some cases, hiccups can express something more profound. They often serve as a sign that something’s amiss, sometimes grave: many cases of the benign hiccups can, in one way or another, be tied to sarcoidosis, a multi-system inflammatory disorder [6], and even extreme hiccupping has been reported in COVID-19 [10].
How Can We Stop Hiccupping?
Hiccupping is annoying, but there are several things you can try to get rid of it. One thing you might have heard before is to take a breath and hold it for about 15 or 20 seconds [11]. Another method is to breathe into a paper bag, which increases the level of carbon dioxide in your lungs, which relaxes your diaphragm [11, 3].
Drinking or gargling with water or ice water can also be helpful [11, 12, 3]. This method can soothe any irritation in your diaphragm and potentially stop the hiccups [3].
Another involves stimulating the back of your throat by swallowing a teaspoon of sugar [11, 12]. This works because interrupting the regular breathing cycle may momentarily halt the hiccups [12].
A course of action that also often works is the Valsalva manoeuvre, where you bear down while holding your breath. Since this interrupts the hiccup reflex arc and halts your hiccuping cycle, it sometimes works [11, 12].
In other circumstances, a more aggressive approach might be required; the Hiccup relief using Active Prolonged Inspiration (HAPI) technique – in which one inhales maximally and then attempts to inspire when the glottis is open for a total of 30 seconds – has been quite effective at eliminating hiccups in several patients [13].
So, if they last, medical therapy is necessary. One device using high suction pressure to draw fluid into the mouth can work up to 90% of the time [14].
In severe cases, physical disruption of the phrenic nerve, hypnosis, and acupuncture have been used [15].
Of course, it must be said that although these methods can be effective, no one has yet discovered a bulletproof way to cure the hiccups, and what works for one person might not work for another [3].
Are Hiccup Contagious?
Hiccups are not contagious. They are sudden involuntary spasms of the diaphragm and intercostal muscles, followed by a quick closure of the glottis, that elicit an explosive sound, usually described as ‘Hic!’ [10, 16]. Hiccups are separated into the acute pattern that lasts less than 48 hours and the persistent pattern that lasts more than 48 hours [17].
Hiccups have a few well-characterised triggers, including certain diseases, medications, and stress [16, 18]. But they are not contagious diseases like croup, which can be contracted while sneezing on a crowded bus. Croup is a virus that causes extreme irritation to the upper portion of the breathing airway [18].
Hiccups are ordinarily not contagious but can be a sign or symptom of an infectious disease. For example, several cases of hiccups lasting longer than 48 hours emerged as one of the signs of COVID-19 [10, 16, 19]. However, this is a rare occurrence, and further research is required to clarify the relationship between PCH and COVID-19 [16].
In conclusion, while hiccups can be a symptom of a contagious disease, they are not contagious.