Intractable Hiccups

  • Stasia Rouse
  • Matthew WodziakEmail author
Neurology of Systemic Diseases (J Biller, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Neurology of Systemic Disease


Purpose of Review

Hiccups are a common problem that crosses multiple disciplines including neurology, gastroenterology and pulmonology, and primary care. There are no formal guidelines to the treatment of intractable hiccups and treatment is based on experience and anecdotal evidence often relying on older medications. We have reviewed the relevant literature with an emphasis on the last five years or so in management of intractable hiccups.

Recent Findings

The production of hiccups is a complex mechanism which involves multiple neurotransmitters and anatomical structure within the central and peripheral nervous system. A number of medications and other therapy have been reported successful for intractable hiccups.


Intractable hiccups can occur more often than we realize and present to multiple medical disciplines. A number of pharmacologic option have been found to be useful including dopamine-blocking medication, baclofen, and gabapentin along with anticonvulsants.


Hiccups Singultus Intractable  Baclofen Gabapentin Medulla oblongata 


Compliance with Ethical Standards

Conflict of Interest

Stasia Rouse declares no potential conflicts of interest.

Matthew Wodziak reports personal fees from Medtronic for consultancy.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Singer C. A cure for hiccups? Retired farmer Charles Osborne isn’t holding his breath—he’s had them for 60 years. People. 1982;Google Scholar
  2. 2.
    The Stanford Daily October 7, 1958 Vol 134 Number 8.Google Scholar
  3. 3.
    Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manag. 2009;38(3):460–5.CrossRefGoogle Scholar
  4. 4.
    Chang F, Lu C. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil. 2012;18:123–30. Scholar
  5. 5.
    Howes D. Hiccups: a new explanation for the mysterious reflex. Bioessays. 2012;34:451–3.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    •• Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015;42:1037–50. Very good summaries and review of literature. CrossRefPubMedGoogle Scholar
  7. 7.
    •• Nausheen F, Mohsin H, Lakhan SE, et al. SpringerPlus. 2016;5(1):1357. Very good summaries and review of literature. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Howard RS. Persistent hiccups. BMJ: Br Med J. 1992;305(6864):1237–8.CrossRefGoogle Scholar
  9. 9.
    Hao XT, Wang L, Yan B, Zhou HY. Intractable hiccup caused by spinal cord lesions in demyelination disease. J Spinal Cord Med. 2013;36(6):711–4.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Polito NB, Fellows SE. Pharmacologic interventions for intractable and persistent hiccups: a systematic review. J Emer Med. 2017;53(4):540–9. Scholar
  11. 11.
    Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc. 2002 Jun;94(6):480–3.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Dobelle WH. Use of breathing pacemakers to suppress intractable hiccups of up to thirteen years duration. ASAIO J. 1999;45(6):524–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Rey E, Elola-Olaso CM, Rodríguez-Artalejo F, Locke GR, Díaz-Rubio M. Prevalence of atypical symptoms and their association with typical symptoms of gastroesophageal reflux in Spain. Eur J Gastroenterol Hepatol. 2006;18(9):969–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Khorakiwala T, Arain R, Mulsow J, Walsh TN. Hiccups: an unrecognized symptom of esophageal cancer? Am J Gastroenterol. 2008;103(3):801.CrossRefPubMedGoogle Scholar
  15. 15.
    Ray P, Zia Ul Haq M, Nizamie SH. Aripiprazole-induced hiccups: a case report. Gen Hosp Psychiatry. 2009;31:382–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Oshima T, Sakamoto M, Tatsuta H, Arita H. GABAergic inhibition of hiccup-like reflex induced by electrical stimulation in medulla of cats. Neurosci Res. 1998;30(4):287–93.CrossRefPubMedGoogle Scholar
  17. 17.
    Petroianu G, Hein G, Petroianu A, Bergler W, Rufer R. Idiopathic chronic hiccup: combination therapy with cisapride, omeprazole, and baclofen. Clin Ther. 1997;19(5):1031–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Davis JN. An experimental study of hiccup. Brain. 1970;93(4):851–72.CrossRefPubMedGoogle Scholar
  19. 19.
    Abubaker AK, Rabadi DK, Kassab M, Al-Qudah MA. Persistent hiccups after cervical epidural steroid injection. Am J Case Rep. 2018;19:397–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jochim A, Castrop F, Gempt J, Haslinger B. Periodic hiccup in patients with subthalamic deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord. 2015;21(9):1117–8.CrossRefPubMedGoogle Scholar
  21. 21.
    De Bie RM, Speelman JD, Schuurman PR, Bosch DA. Transient hiccups after posteroventral pallidotomy for Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1999;67(1):124–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Sweeney J, Bodman A, Hall WA. Brain abscess of basal ganglia presenting with persistent hiccups. World Neursurg. 2018;112:182–5.CrossRefGoogle Scholar
  23. 23.
    Hashiguchi M, Fujita A, Ikeda M, Morikawa M, Kohmura E. Intractable hiccups after coil embolization of partially thrombosed posterior inferior cerebellar artery aneurysm. World Neurosurg. 2018;111:251–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Takemoto Y, Hashiguchi A, Moroki K, Tokuda H, Kuratsu J. Chronic subdural hematoma with persistent hiccups: a case report. Interdiscip Neurosurg. 2016;3:1–2.CrossRefGoogle Scholar
  25. 25.
    Caloro M, Pucci D, Calabro G, de Pisa E, Mancinelli I, Rosini E, et al. Development of hiccup in male patients hospitalized in a psychiatric ward: is it specifically related to the aripiprazole-benzodiazepine combination? Clin Neuropharmacol. 2016;39(2):67–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Lertxundi U, Marquinez AC, Domingo-Echaburu S, Solinis MA, Calvo B, Del Pozo-Rodriguez A, et al. Hiccups in Parkinson’s disease: an analysis of cases reported in the European pharmacovigilance database and a review of the literature. Eur J Clin Pharmacol. 2017;73:1159–64.CrossRefPubMedGoogle Scholar
  27. 27.
    Nguyen KP, Pai V. Sternoclavicular joint (SCJ) septic arthritis presenting as excruciating cervical and chest pain with intractable hiccups. Chest. 2017;152(4):A115.CrossRefGoogle Scholar
  28. 28.
    Munveer T, Cohen DA, Pulmonary embolism presenting as persistent hiccups, Am J Med 2018; 131(2).Google Scholar
  29. 29.
    McGrane IR, Shuman MD, McDonald RW Donepezil-related intractable hiccups: a case report. Pharmacotherapy 2015;35(3)e1–5.Google Scholar
  30. 30.
    Panchal R, Bhutt V, Anovadiya A, Purohut B, Dekhaiya F, Goswami N. Tramadol-induced hiccups: a report of two cases Druf Saf- Case Rep 2018; 5(3).Google Scholar
  31. 31.
    Williamson BW, MacIntyre IM. Management of intractable hiccup. Br Med J. 1977;2(6085):501–3.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kako J, Kobayashi M, Kanno Y, Tagami K. Intranasal vinegar as an effective treatment for persistent hiccups in a patient with advanced cancer undergoing palliative care. J Pain Symptom Manag 2017;54(2).Google Scholar
  33. 33.
    Peleg R, Peleg A, Case report: sexual intercourse as potential treatment for intractable hiccups Can Fam Physician 2000;46:1631–1632.Google Scholar
  34. 34.
    Lee C, Tong LP. Termination of persistent hiccups by digital rectal massage. J Emerg Med. 2017;52(2):e55.CrossRefPubMedGoogle Scholar
  35. 35.
    Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013, Issue 1. Art. No.: CD008768. DOI:
  36. 36.
    Grononger H, Cheng M A Case of persistent hiccups successfully managed with pregabalin. Progress in Palliative Care 2015; 23(4).Google Scholar
  37. 37.
    Lee JH, Kim TY, Lee HW, Choi YS, Moon SY, Cheong YK. Treatment of intractable hiccups with an oral agent monotherapy of baclofen. Korean J Pain. 2010;23(1):42–5.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Kim JE, Lee MK, Lee DH, Choi SS, Park JS. Continuous cervical epidural block: treatment for intractable hiccups. Medicine (Baltimore). 2018;97(6):e9444.CrossRefGoogle Scholar
  39. 39.
    Pittman T, DiStephano A, Chow R, Samet R Ultrasound-guided phrenic nerve block for intractable hiccups in patients with metastatic colon cancer: a case report J Palliat Care Med 2017; 7(3).Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyLoyola UniversityMaywoodUSA

Personalised recommendations