Hiccups (Singultus): Review and approach to management

doi:10.1016/S0196-0644(05)81620-8

Annals of Emergency Medicine

Volume 20, Issue 5, May 1991, Pages 565-573

https://doi.org/10.1016/S0196-0644(05)81620-8 Get rights and content

Summary

Hiccups are a common, and fortunately usually transient, benign malady. Occasionally, however, hiccups fail to resolve spontaneously, resulting in patient fatigue and incapacitation and the need for the affected individual to seek medical care for resolution of the problem.

The approach to the management of these patients consists of the identification and treatment of serious underlying causes of the episode as well as therapeutic interventions to achieve hiccup resolution.

References (113)

ShayS et al.
Hiccups associated with reflux esophagitis
Gastroenterology
(1984)
StineR et al.
Hiccups: An unusual manifestation of an abdominal aortic aneurysm
JACEP
(1979)
BrouilletteR et al.
Hiccups in infants: Characteristics and effects on ventilation
J Pediatr
(1980)
WagnerM et al.
Persistent hiccups
Ann Emerg Med
(1982)
ShimC
Motor disturbances of the diaphragm
Clin Chest Med
(1980)
CampbellM
Malignant hiccup
Am I Surg
(1940)
DunnP
Fetal hiccups
Lancet
(1977)
CroninR
Psychogenic polydipsia with hyponatremia: Report of eleven cases
Am J Kidney Dis
(1987)
JonesJ et al.
Persistent hiccups as an unusual manifestation of hyponatremia
J Emerg Med
(1987)
KaufmannH
Hiccups: An occasional sign of esophageal obstruction
Gastroenterology
(1982)

DriscollC

Symptom control in terminal illness

Prim Care

(1987)

OsbornH et al.

Single-dose oral phenytoin loading

Ann Emerg Med

(1987)

DavisJ

An experimental study of hiccup

Brain

(1970)

McFarlingD et al.

Hoquet diabolique: Intractable hiccups as a manifestation of multiple sclerosis

Neurology

(1979)

CooneyC et al.

Prolonged singultous as a result of barbiturate toxicity

Ir Med J

(1987)

NathanM et al.

Intractable hiccups

Laryngoscope

(1980)

BaethgeB et al.

Intractable hiccups associated with high dose intravenous methylprednisolone therapy

Ann Intern Med

(1986)

RosenowE

Diaphragmatic spasms in animals produced with a Streptococcus from epidemic hiccup: Preliminary report

JAMA

(1921)

SwannI

Intrauterine hiccup

Br Med J

(1978)

SouadjianJ et al.

Intractable hiccups: Etiological factors in 220 cases

Postgrad Med

(1968)

FisherC

Protracted hiccup — A male malady

Trans Am Neurol Assoc

(1967)

AnthoneyT et al.

On temporal structure of human hiccups: Ethology and chronobiology

Int J Chronobiol

(1978)

MayoC

Hiccup

Surg Gynecol Obstet

(1932)

Bellingham-SmithE

The significance and treatment of obstinate hiccough

Practitioner

(1938)

NobleE

Hiccup

Can Med Assoc

(1934)

BaileyH

Persistent hiccup

Practitioner

(1943)

LewisJ

Hiccups: Causes and cures

J Clin Gastroenterol

(1985)

GigotA et al.

Treatment of hiccups

JAMA

(1952)

SamuelsL

Hiccup: A ten year review of anatomy, etiology, and treatment

Can Med Assoc J

(1952)

TravellJ

A trigger point for hiccup

J Am Osteopath Assoc

(1977)

GrahamD

Esophageal motor abnormality during hiccup

Gastroenterology

(1986)

HemachudaT et al.

Intractable hiccups (singultus) as presenting manifestation of Japanese encephalitis

J Med Assoc Thai

(1984)

KappisM

Ein beitrag zur enistehung und behanlung des singultus

Klin Wochenschr Jahrgang

(1924)

MillerF et al.

Fetal hiccups: An associated fetal heart rate pattern

Obstet Gynecol

(1983)

ScarnatiR

Intractable hiccup (singultus): Report of a case

J Am Osteopath Assoc

(1979)

ObisP

Remedies for hiccups

Nursing

(1974)

GluckM et al.

Chronic hiccups and gastroesophageal reflux disease: The acid perfusion test as a provocative maneuver

Ann Intern Med

(1986)

HermanJ et al.

A bitter cure

N Engl J Med

(1981)

LewittP et al.

Hiccup with dexamethasone therapy

Ann Neurol

(1982)

FischerA et al.

Intractable hiccups as presenting symptom of brainstem tumor in children

Child Brain

(1982)

KarianJ et al.

Intractable hiccups: A complication of ventriculoperitoneal shunt: Case report

Neurosurgery

(1980)

RosenowE

Further studies on the etiology of epidemic hiccup (singultus) and its relation to encephalitis

Arch Neurol Psychiatr

(1926)

BrainW

Epidemic hiccup and encephalitis lethargica

Br Med J

(1923)

ByrnesC

Hiccup crisis in tabes dorsalis

Bull Johns Hopkins Hosp

(1935)

CardiE

Hiccups associated with hair in the external auditory canal — Successful treatment by manipulation

N Engl J Med

(1961)

BenderM et al.

Diseases of the peritoneum, mesentary and diaphragm

RothJ

Hiccup

JohnsonJ et al.

Splenic abscess complicating infectious endocarditis

Arch Intern Med

(1983)

Cited by (148)

Use of osteopathic manipulative treatment in management of intractable singultus and associated symptoms
2023, International Journal of Osteopathic Medicine
A 23-year-old female, with ongoing hiccups for five years, known as intractable singultus, was managed with osteopathic manipulative treatment (OMT) to decrease her hiccup bouts and decrease the following associated symptoms: mid-thoracic back pain, nausea, vomiting, reflux, eructation, and abdominal pain. Unlike other documented OMT-managed singultus cases, this patient had no known chronic medical conditions, a limited past medical history, and the longest documented case of singultus to be treated with OMT.
The patient was evaluated at six visits, four including OMT. Areas of somatic dysfunction were treated with myofascial release, muscle energy technique, counterstrain, and high velocity low amplitude. Objective measures include patient-recorded singultus bouts before and after treatment.
Prior to OMT, the patient averaged approximately 60 hiccups per day with a recorded maximum of 97 hiccups. After the first OMT session, the average number of daily hiccups was reduced nearly 50% (∼30 hiccups per day), and the maximum was reduced by approximately 39% (59 hiccups per day). Additionally, with the exception of mid-thoracic back pain, there was a reduction in associated symptoms of eructation, reflux, abdominal pain, nausea (resolved), and emesis (resolved), which improved the patient's quality of life.
There is little literature surrounding the applications of OMT in the management of chronic and intractable singultus. Thus, this case serves as a foundation for future publications. Based on this case, the authors propose that OMT appears to be a safe, noninvasive management option for patients with singultus, relieve associated symptoms, and potentially decrease singultus-related complications.
Hiccups as a specific neurological manifestation in males with COVID-19
2021, IDCases
Several clinical manifestations of COVID-19 have been reported in the literature since then. In addition to upper respiratory symptoms, dysgeusia and anosmia are relatively common neurological manifestations with COVID-19. We had five cases of hiccups in succession; therefore, we assume that hiccups might be a specific symptom of COVID-19. We retrospectively analyzed 46 patients with COVID-19 diagnosed from February 2021 to May 2021. Among the 46 patients, 5 developed hiccups (11%). All patients were male. The median age of was 56 years. None of the patients were smokers. Further, all patients exhibited pneumonia without dysgeusia or anosmia. The median onset of hiccups was 5 days after diagnosis, with a median duration of 2 days. All patients recovered from hiccups and COVID-19. Hiccups might be a specific neurological symptom in male patients with COVID-19.
Acute myocardial ischemia associated with hiccups
2019, CMAJ
Prolonged hiccups induced by renal infarction: a case report
2024, Journal of Medical Case Reports
The Association between Molecular Initiating Events and Drug-Induced Hiccups
2024, Pharmaceuticals
An Unusual Hiccup: Severe Singultus as a Symptom in Ulcerative Colitis
2024, ACG Case Reports Journal

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Collective reviewHiccups (Singultus): Review and approach to management

Summary

Gastroenterology

JACEP

J Pediatr

Ann Emerg Med

Clin Chest Med

Am I Surg

Lancet

Am J Kidney Dis

J Emerg Med

Gastroenterology

Prim Care

Ann Emerg Med

An experimental study of hiccup

Brain

Hoquet diabolique: Intractable hiccups as a manifestation of multiple sclerosis

Neurology

Prolonged singultous as a result of barbiturate toxicity

Ir Med J

Intractable hiccups

Laryngoscope

Intractable hiccups associated with high dose intravenous methylprednisolone therapy

Ann Intern Med

Diaphragmatic spasms in animals produced with a Streptococcus from epidemic hiccup: Preliminary report

JAMA

Intrauterine hiccup

Br Med J

Intractable hiccups: Etiological factors in 220 cases

Postgrad Med

Protracted hiccup — A male malady

Trans Am Neurol Assoc

On temporal structure of human hiccups: Ethology and chronobiology

Int J Chronobiol

Hiccup

Surg Gynecol Obstet

The significance and treatment of obstinate hiccough

Practitioner

Hiccup

Can Med Assoc

Persistent hiccup

Practitioner

Hiccups: Causes and cures

J Clin Gastroenterol

Treatment of hiccups

JAMA

Hiccup: A ten year review of anatomy, etiology, and treatment

Can Med Assoc J

A trigger point for hiccup

J Am Osteopath Assoc

Esophageal motor abnormality during hiccup

Gastroenterology

Intractable hiccups (singultus) as presenting manifestation of Japanese encephalitis

J Med Assoc Thai

Ein beitrag zur enistehung und behanlung des singultus

Klin Wochenschr Jahrgang

Fetal hiccups: An associated fetal heart rate pattern

Obstet Gynecol

Intractable hiccup (singultus): Report of a case

J Am Osteopath Assoc

Remedies for hiccups

Nursing

Chronic hiccups and gastroesophageal reflux disease: The acid perfusion test as a provocative maneuver

Ann Intern Med

A bitter cure

N Engl J Med

Hiccup with dexamethasone therapy

Ann Neurol

Intractable hiccups as presenting symptom of brainstem tumor in children

Child Brain

Intractable hiccups: A complication of ventriculoperitoneal shunt: Case report

Neurosurgery

Further studies on the etiology of epidemic hiccup (singultus) and its relation to encephalitis

Arch Neurol Psychiatr

Epidemic hiccup and encephalitis lethargica

Br Med J

Hiccup crisis in tabes dorsalis

Bull Johns Hopkins Hosp

Hiccups associated with hair in the external auditory canal — Successful treatment by manipulation

N Engl J Med

Collective review
Hiccups (Singultus): Review and approach to management