What causes hiccups, and what is the cure?


What's with hiccups? What are our stomachs doing down there? And once and for all, what's the cure?

-- C.F., Spring Valley

Our stomachs? Our stomachs are just hanging around digesting, I guess. And maybe wondering what all the racket is upstairs. The operative body parts in a hiccup attack are your diaphragm and your glottis. Your stomach's just an innocent bystander, most of the time. Although, in some cases, it may have started the episode in the first place.

Your diaphragm, of course, is the flat muscle that forms the floor of your chest cavity (above your stomach) that helps your lungs expand and relax. That's where the jerking comes from. Your glottis, the part that actually produces the hic, is the space between your vocal cords ("vocal folds," actually, to head off letters from speech pathologists). A good, eyeball-ratting attack of hiccups gets started with an irritation of your respiratory or digestive system that eventually aggravates your diaphragm or your phrenic nerve (the motor nerve that carries impulses from your spinal cord to your diaphragm). This can come from eating or drinking too quickly, improper swallowing, indigestion, stress, excessive alcohol, smoking, prolonged laughing, exercising too soon after a meal, pregnancy, or some diseases. Your irritated diaphragm goes into spasms, causing you to inhale suddenly, then your vocal cords snap closed. Pretty soon you're twitching and hiccing, which stimulates the people around you to begin making suggestions about how to get rid of them.

The secret to stopping a hiccup attack is stopping the diaphragm spasms. Medical sources suggest the most reliable way is to breathe air with a high carbon dioxide content (rebreathing air in a paper bag) or holding your breath. Of course, we all know that holding your breath only helps until you finally exhale, when you invariably start hiccing again. Some alternative suggestions are holding your breath and drinking a glass of water, swallowing crushed ice, or placing an ice bag on the area of your diaphragm or on the back of your neck (the origin of the phrenic nerve). But everybody has pet suggestions, most of which involve drinking a glass of water in some contorted position, more for the amusement of the spectators than because it actually works.

Most hiccups go away on their own when the whole system becomes fatigued. There's usually nothing dangerous about them. They're just glitches in the human circuitry in which a nerve impulse gets turned on and can't turn itself off. Like a twitchy eyelid or other tic. That said, I will add that the longest hiccup attack on record is held by a man from Iowa, who started hiccing in 1922 and was still going strong in 1986. But he said the only problem it's caused him is that his false teeth keep falling out.

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