Strange cures for hiccups

Medical Matters:Medicine is a serious business and so is most of the research associated with it.

But once a year, Harvard University hosts a ceremony (the Ig Nobel awards) honouring science that "first makes you laugh and then makes you think". The event never fails to highlight the bizarre and the quirky.

Last year the Ig Nobel prize for medicine went to Dr Francis Fesmire of the University of Tennessee College of Medicine for his paper describing a unique way to terminate intractable hiccups. When a patient of his did not respond to standard therapies for the symptom, Fesmire, now in some desperation, came up with an unusual solution.

Aiming to stimulate the vagus nerve, which plays a role in hiccups, he stuck his (gloved) finger up the patient's rectum. To the doctor's delight (and one hopes the patient's) the hiccups stopped, leading to the publication of a paper, "Termination of intractable hiccups with digital rectal massage", in the Annals of Emergency Medicine and an Ig Nobel award.

The term hiccups comes from the sound of the symptom. The proper, but hardly ever used, medical term is singultus, from the Latin singult. Roughly translated this means "the act of catching one's breath while sobbing".

Hiccups can be a distressing symptom, especially when it lasts for some time. The term intractable is used for hiccups that have lasted for a month or more.

One unfortunate patient lived with the scourge of uninterrupted hiccups for more than 60 years. Charles Osborne of Iowa started hiccupping in 1922 and kept going for the next 65 years.

What is the mechanism behind hiccups?

They occur when the diaphragm goes into spasm, followed by a quick and noisy closing of the glottis. The diaphragm is the large muscle (shaped like an upturned saucer) that separates the chest from the abdomen; the glottis is the opening between the vocal cords that closes when we are eating to stop food entering the lungs.

There is some evidence for the existence of a "hiccup centre" in the lower part of the brain. The vagus nerve, which controls the opening and closing of the glottis, is linked to it, as is the phrenic nerve which carries signals to and from the diaphragm.

Most bouts of hiccups have no obvious cause. They may be triggered by a combination of laughing, eating, drinking and talking. Occasionally, hot or irritating food is the culprit. Hiccups also occur post-operatively, probably due to irritation of the diaphragm, but they usually settle quickly.

Persistent hiccups raises the possibility of a serious cause, such as a brain tumour or stroke interfering directly with the hiccup centre in the brain.

Other rare but serious causes of hiccups include pneumonia and lung cancer. In kidney failure, high levels of waste substances, such as urea, may accumulate in the blood leading to hiccups.

No single drug treatment has been found to be effective, so a plethora of home and medical remedies have emerged over time. Probably the most popular is holding your breath while counting to 10 or breathing into a brown paper bag, both of which raise the level of C02 in the blood which helps stop hiccups.

Stimulating the vagus nerve also helps. This is achieved by drinking water quickly or by swallowing dry bread or crushed ice. Gently pulling on the tongue or rubbing the eyeballs also introduces vagal stimulation. The pharyngeal nerve can be stimulated by drinking from the wrong side of the cup.

One expert advises "filling a glass of water, bending over forward, and drinking the water upside down".

Remedies such as sucking a lemon wedge soaked with angostura bitters, drinking aniseed liquor or a glass of pineapple juice all have their advocates. Inducing sneezing or inhaling a noxious odour such as ammonia may work.

One old fashioned cure recommended a drink made from two teaspoons of crushed dill seed added to a little hot water. And in the west of Ireland, a favourite remedy for hiccups is to distract the patient by getting him to visualise a green cow grazing in a blue field.

You can try tickling a child with hiccups while at the same time asking them not to laugh. Giving the person a sudden shock works; but perhaps it is best to first check they don't have a history of coronary heart disease.

Massaging the carotid artery at a certain point in the neck blocks the vagal nerve, but it is probably not one to try at home because the stimulation may also interfere with the heart rate.

Among the drugs used for persistent hiccups are the major tranquilliser chlorpromazine, baclofen (an anti-spasmodic), metoclopramide (and anti-nausea drug) and the anti-epileptic gabapentin. All have varying success rates which differ from patient to patient.

While it is hard to envisage people with hiccups queuing up for Fesmire's digital rectal massage, a certain desperation must set in after a few days of suffering.

At which point, even the most unpleasant remedy may be worth trying.

Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot respond to individual medical queries.Medical Matters