The search for a cure for hiccups

A strange straw and a way of holding your breath seem the most promising, but we still have a lot to learn

Charles Osborne had the hiccups shortly after making an effort to lift a pig to be slaughtered. It was 1922, he was thirty years old and he thought that the disorder would go away after a few minutes, as usually happens. Instead, he had to live with hiccups for 68 years: no one was able to find a remedy for the problem, demonstrating how obscure a condition that sooner or later affects everyone is.

In the first decades after the hiccups appeared, Osborne had about 40 spasms (hiccups) per minute, over time the frequency decreased to about twenty in his last years of life. The hiccups disappeared on their own in 1990, giving Osborne a few months of respite before his death in February 1991. According to the Guinness World Recordswas the person who lived the longest with hiccups, with an estimated total of 430 million hiccups.

Osborne’s story is naturally an extreme case, much cited in articles on the subject, but it is true that even today we know very little about hiccups and above all about the remedies to make it go away. From making those who suffer from it a great scare to holding their breath in a certain way through the infamous seven sips of water, there is no shortage of advice to get rid of the hiccups in popular traditions, while they are lacking enough in scientific literature. There is no shortage of research groups that have dealt with it, but with mixed results, even if alleged “definitive solutions to the problem” emerge from time to time. Two in particular are held to be promising, but first let’s review in case you missed the previous installments.

Hiccup
In general, hiccups are caused by a rapid and involuntary contraction of the diaphragm, the layer of muscles and tendons that separates the upper and lower torso, and which allows us to breathe. The spasm involves a rapid inspiration of air and an immediate closure of the glottis, which has among its purposes that of isolating the esophagus from the trachea, i.e. the digestive system from the airways.

It is the combination of the inspiration and the quick click of the glottis that brings the classic hic of hiccups. As often happens with health matters, depending on how you are made you can have a hiccup with a high frequency of hiccups, spasms of variable intensity and consequently jolts and hic more or less strong.

It is still not completely clear what the hiccups themselves are used for. A rather shared hypothesis is that the spasms serve to develop the fetus’ ability to breathe in preparation for leaving the maternal uterus, therefore for the passage from a condition in which it is substantially submerged to one in which it must enter for the first time air in your lungs. Others hypothesize instead that hiccups are a memory left by evolution, linked to our very distant amphibious ancestors who had to regulate their breathing depending on whether they were in water or on dry land.

What causes hiccups
The analyzes on come suffer from hiccups have shown that the spasm involves a reflex arc, i.e. a nervous reaction that does not concern the superior nervous centers and on which we therefore do not have direct control. One of the main suspects is the vagus nerve together with the phrenic nerve. The vagus (there are two, one right and one left) starts from the medulla oblongata – the lowest part of the brainstem – and reaches the lower chest and abdomen. The phrenic (also in this case there is one on each side), on the other hand, starts from the cervical spinal nerves and innervates a large part of the diaphragm.

If part of these long nerves become irritated, hiccups can occur. Vagus and phrenic can be disturbed by various causes. At the end of a meal, for example, the increased dilation of the stomach can interfere with the two nerves, leading to their reaction that disturbs the normal nerve signals received by the diaphragm, causing it to contract abnormally. However, hiccups can also occur on an empty stomach, for example if you are ingesting a carbonated drink, which leads to a sudden and temporary dilation of the stomach walls. An attack of hiccups can also occur after a particularly intense coughing fit, for example due to something gone wrong (sometimes saliva is enough), or to an effort as Osborne is told.

Usually cases of hiccups last a few minutes and leave no consequences, but as we have seen a lot can depend on their causes and on how each of us is made. Particular states of anxiety, severe stress, lack of sleep, lack of vitamins or mineral salts, problems with the digestive system, can in turn cause hiccups. In the case of chronic conditions, the episodes can be recurrent. In rare circumstances, the spasms can be caused by diseases such as tumors of the brain, stomach, lungs or diaphragm itself. Degenerative neurological diseases, such as Parkinson’s and some forms of multiple sclerosis, can also lead to an increased frequency of hiccups.

Remedies
Cases of hiccups attributable to some of these causes can be treated easily, for example by correcting behaviors or removing the most likely causes of the attacks. It is recommended to reduce the consumption of carbonated drinks or spicy foods, to eat more slowly and less, possibly increasing the frequency of meals. In cases of persistent hiccups, however, tests and tests are necessary to identify health problems that could be more serious.

The list of home remedies for occasional hiccups is quite long and often includes quite creative solutions that work for some people and not for others. A sudden loud noise to startle the hiccups seems to work because it leads to a nervous reaction that interrupts the hiccups. Other activities, such as holding your breath or slowly drinking a few sips of water without breathing, seem to help because they focus your attention on something else: you calm down and consequently relax your diaphragm, reducing spasms. However, not all experts agree on these explanations and it cannot be excluded that sometimes the hiccups go away by themselves, by chance, at the very moment in which some solution is being tried to get rid of them.

Ali Seifi is a neurologist at the University of Texas San Antonio (USA), is an expert in brain damage and is considered a point of reference when it comes to hiccups. He believes that ultimately there is a bit of science to home remedies, as he recently told TheAtlantic: “They spread through trial and error.” Seifi believes that valid remedies have one thing in common: a small change in internal pressure that affects the behavior of the diaphragm. The problem is that they don’t always allow you to reach the right pressure, so they don’t work all the time.

Starting from these considerations, in 2015 Seifi began working on a new device that would allow the desired pressure to be obtained on the diaphragm. After various prototypes, he came to develop a sort of straw that generates while drinking a pressure capable of lowering the diaphragm and moving the epiglottis. The straw is called HiccAway and has been on sale for a couple of years for just under $14. It doesn’t always work, also because as we have seen the causes of hiccups can be multiple, but most of those who have experienced it said they have gotten better than other home remedies.

However, there is another system that seems to offer good results and which does not involve the purchase of a straw. This was reported about twenty years ago by Luc Morris, a surgeon specializing in head and neck cancer today at the Memorial Sloan Kettering Cancer Center in New York. When he was still a university student, he had written a letter in the scientific journal Anesthesia & Analgesia pointing out a technique he had termed “supra-supramaximal inspiration” (SSMI).

The SSMI involves exhaling completely, then taking a big breath and holding your breath for ten seconds. At the end of the short interval one should not immediately exhale, but inhale a little more air and wait another five seconds, then inhale a little more air. Finally, you exhale and breathe normally again. By then the hiccups should be gone, at least in Morris’s experience.

In an experiment conducted on 19 volunteers (12 men and seven women) with hiccups lasting from 20 minutes to 8 hours depending on the case, Morris found an “immediate end” of the hiccups in 16 of 19 cases, equal to 84 percent . The other three volunteers had failed to complete the entire operation of successive breaths to be held, thus making it difficult to evaluate cases in which the system simply does not work.

Morris never conducted a larger and more in-depth clinical study, both for reasons of time and lack of funding. There is not great interest from potential lenders, both public and private, also because a study of this type could lead to the conclusion that it is enough to breathe in a certain way to get rid of the hiccups, nothing particularly profitable.

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