Hiccups: causes, how to stop them and when to see a GP

The NHS says there are things you can do yourself to stop or prevent hiccups, although there is no evidence that they work for everyone. NICE Clinical Knowledge Summaries groups the self-help remedies by how they are thought to work: stimulating the nasopharynx, interrupting normal breathing and counter-irritating the diaphragm.

The NHS says there is often no obvious reason why you get hiccups, but some people find certain things trigger them, such as stress, strong emotions like excitement, and eating and drinking.

NICE CKS says benign hiccups can be caused by gastric distension from swallowing air, excessive food and alcohol or carbonated drinks, irritants to the gut or lungs such as spicy food or smoking, sudden changes in temperature such as cold showers or hot or cold drinks, sudden excitement, and emotional stress and anxiety.

NICE CKS describes hiccups as an involuntary (reflex) diaphragmatic contraction that causes sudden inspiration, with the incoming air stopped by closure of the glottis, which makes the characteristic sound. It says hiccups do not appear to perform any useful or protective function.

Marie Curie says hiccups are sudden, involuntary contractions of the muscles used for breathing, including the diaphragm, and that air rushes into the lungs against closed vocal cords, making the "hic" sound. It says most hiccups are harmless and stop within minutes or hours.

The NHS says hiccups should only last a few minutes, and you can usually wait for them to go away. NICE CKS describes transient hiccups as usual and lasting less than 48 hours, and persistent or protracted hiccups as rare and lasting more than 48 hours.

Marie Curie uses the following terms: hiccups that last between 48 hours and one month are called persistent (or protracted) hiccups, and hiccups that last more than one month are called intractable hiccups. It says hiccups that last up to 48 hours might not be a sign of anything serious, but persistent hiccups can be frustrating and distressing and may disrupt talking, eating, drinking and sleeping.

The NHS says to see a GP if your hiccups last longer than 48 hours, or if they come back very often and are affecting your life.

NICE CKS says that if hiccups have lasted more than 48 hours, a full assessment should be performed to assess whether there is an underlying cause. Investigations a GP may consider include a full blood count, urea and electrolytes, inflammatory markers, liver function tests, an ECG and a chest X-ray. Persistent hiccups may cause complications such as fatigue and weight loss, and it advises reporting any signs of cardiac arrhythmias, insomnia, weight loss and oesophagitis.

The NHS says a GP will want to find out if your hiccups are caused by a health condition or a medicine you are taking. Treating the condition or changing your medicine should stop your hiccups. If there is no obvious cause, they might be able to prescribe a medicine called chlorpromazine, which does not work for everyone.

NICE CKS says that for people in whom an underlying cause cannot be identified, or whose hiccups persist after treatment, a GP can consider physical techniques to interrupt the hiccup reflex arc and specialist referral so that medicine can be started. It lists baclofen, chlorpromazine and metoclopramide among drug options and says acupuncture, hypnosis and psychotherapy can be tried. NICE CKS notes that there is limited evidence to support medicines for hiccups and no formal guidelines, and that for severe, persistent hiccups specialist referral for disruption of the phrenic nerve may be considered.

The NHS says hiccups that last longer than 48 hours can sometimes be due to a medicine you are taking. NICE CKS lists dexamethasone, diazepam, opioids, sulfonamides, anti-epileptics, dopamine agonists and alpha-methyldopa as medicines that can be linked to hiccups, and notes that alcohol can also trigger them.

Marie Curie says medicines do not often cause hiccups but in some cases certain medicines may start them, and advises not to stop taking your medicines unless advised to by your doctor or specialist nurse. If you think a medicine might be causing your hiccups, speak to your doctor or specialist nurse.

Short bouts of hiccups are managed at home. On the NHS, a GP can assess hiccups that last longer than 48 hours, look for a cause and refer you to a specialist if needed. People with serious illness may be supported by a palliative care team.

Private GP or specialist appointments can offer quicker assessment, but the NHS and NICE guidance on when to seek help and the investigations and treatments considered are the same whichever route you choose.