Singultus is the medical word for hiccups. It means short, sudden, jerky breaths that you cannot control. These happen because the main breathing muscle (the diaphragm) and the small muscles between the ribs suddenly squeeze, and then the voice box closes and makes the “hic” sound. Most of the time singultus is harmless and stops by itself after a short time, but sometimes it can last longer and become very annoying or even serious.
Singultus is the medical name for hiccups. It means sudden, repeated, tiny spasms (jerks) of the diaphragm, the big breathing muscle under your lungs. After each spasm, your voice box closes for a moment and makes the “hic” sound.1
Doctors use three simple time groups. “Acute” hiccups last less than 48 hours. “Persistent” hiccups last more than 48 hours. “Intractable” hiccups last more than one month and can make it hard to sleep, eat, or talk normally.2
Chronic singultus is often not a disease by itself. It is usually a sign that something is irritating the hiccup reflex pathway, such as acid reflux, nerve irritation, brain problems, lung or stomach disease, medicines, or even surgery.3
Other names of singultus
Doctors use several other names for singultus. In everyday life people say “hiccups.” Older texts may use “hiccough,” which is just a different spelling. Another technical name is “synchronous diaphragmatic flutter (SDF),” which describes how the diaphragm jumps suddenly and repeatedly. All these names point to the same basic problem: repeated, involuntary contractions of the breathing muscles with a “hic” sound.
How the hiccup reflex works
A hiccup is caused by a special reflex circuit in the body. First, something irritates or stimulates nerves in the chest, neck, stomach, or brain. These signals travel along the vagus nerve, the phrenic nerve, and some spinal nerves to centers in the brainstem. The brainstem then sends signals back through the phrenic nerve to the diaphragm and other breathing muscles, making them contract suddenly. Right after this fast breath in, the space between the vocal cords (the glottis) closes, and that makes the sharp “hic” sound.
Types of singultus
Doctors usually sort singultus into types based on how long it lasts, and sometimes based on the main cause. This helps them decide how serious the problem might be and what tests are needed.
Acute singultus (short-term hiccups)
This type lasts less than 48 hours. It is very common and usually happens after simple triggers like eating or drinking too fast. Most people with acute singultus do not need tests or treatment, because it stops on its own.Persistent singultus
Persistent singultus lasts more than 48 hours but less than one month. At this point, doctors start to worry that there might be an underlying medical problem, such as acid reflux, infection, or a nerve problem. Persistent singultus often needs a careful medical history, physical exam, and some basic tests.Intractable or chronic singultus
Intractable singultus lasts more than one month. It is rare but can be very serious. Long-lasting hiccups can lead to weight loss, poor sleep, depression, and poor quality of life, so doctors look very carefully for causes in the brain, chest, abdomen, or metabolism.Reflex singultus (triggered by stomach or chest problems)
This type is mainly caused by irritation or stretching of the stomach, esophagus, or chest structures, such as with acid reflux, hiatal hernia, or overeating. The irritation activates the nerves that feed into the hiccup reflex arc, especially the vagus nerve.Central nervous system–related singultus
Here, the main problem lies in the brain or spinal cord, such as stroke, tumors, infection, or inflammation in the brainstem. The brainstem helps control breathing and the hiccup reflex, so disease in this area can cause severe or long-lasting hiccups.Metabolic or systemic singultus
In this type, changes in the blood or body chemistry, such as kidney failure, high or low blood sugar, or abnormal electrolytes, irritate the nervous system and trigger hiccups. These problems affect the excitability of nerves and muscles, including those involved in breathing.Drug-induced singultus
Some medicines, such as steroids, certain chemotherapy drugs, anesthetic agents, or dopamine-related drugs, are known to cause hiccups in some people. These medications may change brain chemicals or irritate the diaphragm reflex arc.
Causes of singultus (20 causes)
Many different things can trigger the hiccup reflex. Often more than one factor works together. Below are 20 important causes, each described in simple language.
Eating too fast or overeating
When people eat a large meal or swallow food very quickly, the stomach can stretch too much. This stretching irritates the diaphragm and the nearby nerves, especially the vagus nerve, and this can start a run of hiccups.Drinking carbonated or very hot/cold drinks
Fizzy drinks fill the stomach with gas, and very hot or very cold fluids can shock the esophagus or stomach lining. These sudden changes send strong signals through the nerves connected to the hiccup reflex arc and may trigger singultus.Sudden changes in stomach temperature or content
Swallowing air (aerophagia), chewing gum, or sucking on sweets can send extra air and saliva into the stomach. This air and fluid can cause distension and irritation of the stomach wall and diaphragm, leading to hiccups.Emotional stress, excitement, or laughter
Strong emotions such as excitement, stress, or fear can change breathing patterns and activate the autonomic nervous system. This may trigger rapid breathing or swallowing that irritates the diaphragm or its nerves, causing singultus.Gastroesophageal reflux disease (GERD)
In GERD, acidic stomach contents move back up into the esophagus. The acid can irritate the esophagus and nearby vagus nerve branches. This irritation is a very common cause of persistent hiccups, especially in adults.Hiatal hernia
A hiatal hernia happens when part of the stomach pushes up into the chest through the opening in the diaphragm. This abnormal position can stretch or irritate the diaphragm and its nerves, making hiccups more likely.Esophagitis and other esophageal diseases
Inflammation or ulcers in the esophagus, or problems such as strictures or tumors, can activate sensitive nerve endings. These signals travel to the brainstem and disturb the hiccup reflex arc, leading to repeated singultus.Stomach and intestinal disorders
Conditions like gastritis, peptic ulcer disease, bowel obstruction, or abdominal surgery can cause pain, gas, and distension. This irritation of the abdominal organs and peritoneum can stimulate the phrenic and vagus nerves that control the diaphragm.Liver and gallbladder disease
Enlarged liver, liver tumors, or gallbladder inflammation (cholecystitis) can press against the diaphragm from below. This mechanical pressure or inflammation may provoke the diaphragm to contract suddenly and cause persistent hiccups.Pancreatic disease
Pancreatitis or pancreatic cancer can cause deep upper-abdominal pain and swelling. The inflamed pancreas lies close to the diaphragm and can irritate surrounding nerves, triggering singultus in some patients.Chest infections (pneumonia, bronchitis, pleurisy)
Infections in the lungs or the lining around the lungs can irritate the phrenic nerve as it passes through the chest. This irritation may cause the diaphragm to spasm repeatedly and creates hiccups, especially in persistent cases.Heart problems, including heart attack
Heart disease, including myocardial infarction (heart attack), pericarditis, or heart failure, can irritate the nearby phrenic nerve or change blood flow to the brainstem. In some patients, singultus can be an unusual sign of heart disease.Central nervous system lesions (stroke, tumor, infection)
Problems in the brain or spinal cord, especially in the brainstem, can disturb the hiccup control centers. Strokes, brain tumors, meningitis, or encephalitis can all damage this area and cause severe, intractable hiccups.Head or neck injury and surgery
Injuries, operations, or radiotherapy in the neck can directly harm or irritate the vagus or phrenic nerves. This direct nerve damage or swelling can make the diaphragm fire abnormally, producing frequent singultus.Metabolic problems such as kidney failure (uremia)
When the kidneys do not work properly, waste products build up in the blood. These toxic substances can affect the brain and nerves, making the hiccup reflex arc more excitable and leading to long-lasting hiccups.Electrolyte imbalances
Abnormal levels of sodium, calcium, or potassium in the blood can change how nerves and muscles work. This change can make the diaphragm and related nerves easier to trigger, so hiccups may start more easily and last longer.Diabetes and blood sugar changes
Poorly controlled diabetes, with high or low blood sugar, can damage nerves over time (diabetic neuropathy). It may also change brain function. These factors can disturb the vagus or phrenic nerves and contribute to singultus.Medications (steroids, chemotherapy, anesthesia, dopamine agents)
Certain drugs are known to trigger hiccups in some people. They may act on brain centers, change neurotransmitter levels, or indirectly irritate the diaphragm. Examples include dexamethasone, some chemotherapy regimens, and dopaminergic medications.Alcohol use
Drinking large amounts of alcohol can cause stomach distension, acid reflux, and changes in brain function. These combined effects make the hiccup reflex more active and can lead to prolonged episodes.Psychogenic or functional causes
Sometimes no structural or metabolic cause is found, and stress, anxiety, or other psychological factors seem to play a role. In these cases, the brain’s control over breathing and swallowing becomes unstable, and this can maintain or trigger singultus.
Symptoms of singultus (15 symptoms)
The main symptom is the repeated “hic” sound, but persistent or intractable singultus can cause many other problems.
Repeated “hic” sounds
The classic sign is a series of short “hic” noises. Each sound happens after a sudden inward breath and closing of the vocal cords. The rhythm is often regular, with several hiccups each minute.Jerking of the chest and upper abdomen
Every hiccup is usually felt as a small jump or jerk in the chest or upper tummy area. This is because the diaphragm and nearby muscles contract suddenly and forcefully.Chest or upper-abdominal discomfort
After many hiccups, the muscles can become tired and sore. People often feel a dull ache or pressure in the middle of the chest or just below the ribs.Feeling of air “stuck” or difficulty finishing a breath
The sudden closure of the vocal cords can make it feel like the breath is cut off. Some people describe a strange feeling that air is stuck in the throat or chest when the hiccup happens.Bloating or full feeling in the stomach
Swallowing air during hiccups or the trigger event can cause gas and bloating. The full feeling in the upper abdomen can then further irritate the diaphragm and continue the cycle.Heartburn or sour taste in the mouth
If GERD is the cause, people may notice burning pain behind the breastbone or a sour, bitter taste from acid coming up into the mouth. These reflux symptoms often appear together with singultus.Shortness of breath or breathing discomfort
Frequent hiccups can interrupt normal breathing patterns. In people with lung or heart disease, this may make them feel more breathless or uncomfortable when they try to breathe normally.Trouble eating or drinking
Strong, repeated hiccups can make it hard to swallow food or liquids safely. People may choke or feel that food goes down at the wrong time because the diaphragm and throat muscles are out of rhythm.Poor sleep and insomnia
Persistent or intractable singultus often continues into the night, waking the person repeatedly. This broken sleep can lead to daytime tiredness, irritability, and difficulty concentrating.Fatigue and low energy
When hiccups disturb sleep and eating, the person may feel very tired and weak. Over time, poor rest and reduced food intake can lower energy levels and affect general health.Weight loss and poor appetite
In long-lasting cases, people may avoid eating because it seems to make hiccups worse or because eating becomes uncomfortable. This can lead to weight loss and poor nutrition.Anxiety, embarrassment, or social distress
Loud or constant hiccups can be embarrassing, especially in social or work situations. People may feel anxious, avoid public places, or worry that something serious is wrong with them.Headache or face discomfort
The repeated jerking and pressure changes in the chest and head can sometimes lead to headaches or a feeling of pressure in the face, ears, or sinuses, especially during long bouts.Pain along the diaphragm or ribs
In severe or prolonged episodes, the muscles of the diaphragm and chest wall may become strained. This can cause sharp or aching pain along the lower ribs or under the breastbone with movement or deep breaths.Depression or decreased quality of life in chronic cases
When hiccups last for weeks or months, the constant discomfort, poor sleep, and social problems can lead to low mood and depression. Many reports show that intractable singultus can seriously reduce quality of life.
Diagnostic tests for singultus (20 tests)
Most short-term hiccups do not need tests. But when singultus is persistent or intractable, doctors look for hidden causes. They start with a careful history and physical exam and then use focused tests.
Physical exam tests
General physical examination
The doctor checks vital signs (pulse, blood pressure, breathing rate, temperature) and looks at the whole body. They watch the hiccup pattern, check for weight loss, signs of infection, or other illness. This broad exam helps decide which organs might be involved.Head, neck, and throat examination
The doctor looks in the mouth and throat, checks the neck for swelling or thyroid enlargement, and may look for ear problems or foreign bodies. Problems in these areas can irritate the vagus nerve and trigger singultus, so careful inspection is important.Chest and lung examination
Using a stethoscope, the doctor listens to the lungs and heart, and gently presses on the chest. They look for signs of pneumonia, pleurisy, heart failure, or other chest conditions that might irritate the phrenic nerve and diaphragm.Abdominal examination
The doctor feels the abdomen to check for tenderness, swelling, liver enlargement, gallbladder pain, or masses. They also listen for bowel sounds. Many abdominal diseases can provoke hiccups by irritating the diaphragm from below.
Manual tests and bedside maneuvers
Observation of breathing pattern and hiccup frequency
The doctor may count how often the hiccups occur and how they relate to breathing, speaking, or swallowing. Noting the pattern helps to decide whether the problem is likely to be functional, metabolic, or structural.Swallowing and water-drinking test (bedside check)
The doctor may ask the patient to sip or drink water while they watch for choking, coughing, or worsening hiccups. Difficulty swallowing may point toward esophageal disease, reflux, or nerve problems that need further testing.Bedside neurologic screening tests
Simple checks of eye movements, facial strength, tongue movement, limb strength, reflexes, and coordination can show if there is a problem in the brain or spinal cord. Abnormal findings suggest that brain imaging might be needed.Vagal or carotid sinus stimulation (specialist bedside maneuver)
In some controlled settings, a doctor might gently massage the carotid sinus or perform other vagal maneuvers to see if they stop the hiccups. This is done carefully and usually only by trained clinicians, because it can affect heart rate and blood pressure.
Laboratory and pathological tests
Complete blood count (CBC)
A CBC looks at red cells, white cells, and platelets. It can show anemia, infection, or blood cancers. These conditions may not directly cause hiccups but can point to serious underlying disease that also affects the diaphragm or nervous system.Electrolyte panel (sodium, potassium, calcium, etc.)
This test measures key salts in the blood. Abnormal levels can disturb nerve and muscle function and make the hiccup reflex more active. Correcting these imbalances often helps reduce singultus.Kidney function tests (urea, creatinine)
These values show how well the kidneys are clearing waste. High levels suggest kidney failure (uremia), which can cause or worsen long-lasting hiccups. Treating the kidney problem can improve the symptoms.Liver function tests
These tests check for liver injury or blockage of bile flow. Abnormal results may suggest liver disease, tumors, or gallbladder problems that can press on the diaphragm or irritate nearby nerves.Blood glucose and diabetes screening
Measuring fasting glucose or HbA1c helps detect diabetes or poor blood sugar control. Long-term high sugars can damage nerves, and severe low sugars can disturb brain function, both of which may influence singultus.Inflammatory markers and infection tests
Tests such as C-reactive protein, ESR, or specific infection markers may be used when an inflammatory or infectious cause is suspected, such as meningitis, pneumonia, or abdominal infection. Finding and treating these conditions can stop persistent hiccups.Pregnancy test in women of childbearing age
Because pregnancy can change hormone levels, abdominal size, and reflux risk, a simple urine or blood pregnancy test is often done in young women. This helps avoid unsafe tests and may explain new onset singultus with nausea or reflux.
Electrodiagnostic and functional tests
Electrocardiogram (ECG)
An ECG records the heart’s electrical activity. It helps to detect heart attacks, arrhythmias, or pericarditis that might be linked with hiccups. If chest pain or risk factors for heart disease are present, this test is very important.Electroencephalogram (EEG) in selected cases
An EEG measures electrical activity in the brain. It is sometimes used when seizures or other brain disorders are suspected as the cause of singultus. Abnormal brain waves can guide further neurologic treatment.Phrenic nerve or diaphragmatic electromyography (EMG)
In complex or research settings, EMG can test how well the diaphragm and phrenic nerve are working. It shows abnormal patterns of muscle contraction and can help confirm that the diaphragm is being triggered incorrectly by nerve signals.
Imaging tests
Chest X-ray
A chest X-ray is a simple and widely available imaging test. It can detect lung infection, tumors, enlarged heart, or elevated diaphragm. Because it is quick and low cost, it is often one of the first imaging tests ordered for persistent singultus.CT or MRI of the chest, abdomen, or brain
When serious disease is suspected, doctors may order CT or MRI scans to get detailed pictures. Chest and abdominal imaging can show tumors, hernias, aneurysms, or other masses touching the diaphragm or nerves. Brain MRI or CT can reveal strokes, tumors, or other lesions in the brainstem that disturb the hiccup reflex.Endoscopy or esophageal studies (optional additional test)
In some patients with strong reflux or swallowing problems, doctors may perform upper endoscopy or pH monitoring. These tests show the inside of the esophagus and stomach and measure acid exposure, helping to confirm GERD or other esophageal causes of singultus.
Non-pharmacological (non-drug) treatments for singultus
1. Calm diaphragmatic (belly) breathing
Slow, deep belly breathing can calm the diaphragm and the nerves that control it. You breathe in gently through your nose so your belly rises, then out slowly through your mouth, several times in a row. This steady pattern may interrupt the hiccup reflex and reduce muscle spasms.5
2. Brief breath-holding
Holding your breath for a short time increases carbon dioxide in the blood. This can change the activity of the brainstem center that controls the hiccup reflex and sometimes stops the cycle.5 People with heart or lung disease should do this only under medical advice and never for long periods.
3. Valsalva maneuver (gentle strain)
In this method, you gently bear down as if trying to blow air out while your mouth and nose are closed. This briefly changes pressure in the chest and stimulates the vagus nerve, which can reset the hiccup reflex arc.6
4. Slowly drinking cold water
Sipping cold water steadily can stimulate nerves in the mouth, throat and esophagus, especially the vagus nerve. This strong but harmless sensory input may “distract” the reflex center in the brain and stop hiccups in some people.3
5. Gargling with cold water
Gargling uses both cold stimulation and rhythmic throat muscle movement. This combination can change breathing rhythm and vagus nerve activity. Together, these effects may interrupt the hiccup pattern for a time.5
6. Swallowing sugar or honey
Letting a spoon of granulated sugar or thick honey slowly melt in the mouth strongly stimulates taste and touch receptors on the tongue and palate. This sensory “shock” may temporarily override the hiccup reflex signals.6
7. Gentle tongue pulling
Lightly pulling the tongue forward stretches small muscles and nerves in the back of the throat. This can change nerve signals traveling to the brainstem and may reduce hiccup frequency in some people.6
8. Paper-towel drinking method
In this trick, water is drunk through a clean paper towel or cloth placed over the glass. The extra effort needed for suction makes the diaphragm work in a more controlled way and increases vagal stimulation, which can interrupt hiccups.5
9. Breathing into a paper bag (briefly)
Very short-term breathing into a paper bag raises carbon dioxide levels. This can calm over-active respiratory centers. It should never be done for long periods or in people with heart or lung problems, and only under medical guidance in chronic cases.5
10. Gentle pressure below the ribcage
Light pressure just under the breastbone can slightly push the diaphragm upward. This may change its spasm pattern and reduce hiccups. Pressure must be gentle to avoid pain or injury, especially in anyone with stomach or liver disease.2
11. Knees-to-chest position
Bringing the knees towards the chest while lying or sitting can bend the body and change diaphragm position. This mechanical shift and change in breathing pattern may help some people when combined with slow breathing.1
12. Relaxation, meditation, and stress control
Stress and anxiety can worsen hiccups by increasing breathing rate and muscle tension. Simple relaxation methods, mindfulness, or meditation can calm the nervous system and may reduce the frequency and intensity of chronic singultus episodes.7
13. Acupuncture
Acupuncture places fine needles at specific points along nerves and muscles. Small studies and case reports suggest it may reduce intractable hiccups, especially in palliative care, possibly by modulating brainstem reflex circuits and pain pathways.7
14. Acupressure and ear stimulation
Pressing certain points on the hand, chest, or ear is thought to stimulate the same pathways used in acupuncture. While evidence is limited, these gentle techniques are usually safe and may offer extra comfort in long-lasting hiccups.5
15. Behavioral therapy and biofeedback
For some people, teaching controlled breathing and posture patterns with biofeedback equipment can train the brain to reduce abnormal diaphragm contractions. This may help especially when anxiety, habit, or central nervous system causes keep hiccups going.7
16. Lifestyle changes for acid reflux (GERD)
Because reflux is a common cause of persistent singultus, raising the head of the bed, avoiding lying flat after meals, and eating smaller portions may reduce stomach acid reaching the esophagus and diaphragm and so reduce hiccups.1
17. Avoiding trigger foods and drinks
Spicy foods, very hot or very cold drinks, alcohol, and fizzy drinks can stretch or irritate the stomach and esophagus. Limiting these triggers may lower how often chronic hiccups flare up.3
18. Good sleep habits
Poor sleep increases stress hormones and can worsen many reflex disorders. Regular bedtimes, a dark quiet room, and avoiding heavy late-night meals may indirectly help reduce persistent singultus.2
19. Swallow–breathing coordination exercises
Speech or swallowing therapists sometimes teach exercises that coordinate swallowing and breathing. Better control of these actions may reduce irritation of the throat and upper esophagus that can trigger hiccups in some patients.7
20. Psychological and social support
Very long hiccup attacks can be embarrassing and exhausting. Counseling, support groups, and reassurance that the problem is real and treatable can improve quality of life, even while medical treatment is still in progress.2
Drug treatments for singultus (based on evidence and FDA labels)
Important: These medicines must only be used under a doctor’s supervision. Doses below are general adult patterns from medical and FDA label sources, not personal advice.4
1. Chlorpromazine
Chlorpromazine is an older antipsychotic medicine and is the only drug specifically approved for intractable hiccups in the United States.8 Typical doses for hiccups in adults are around 25–50 mg three or four times daily, adjusted by the doctor according to response.9 It blocks dopamine receptors in the brain, calming the hiccup reflex center. Common side effects include low blood pressure, sleepiness, dry mouth, and movement disorders, so close monitoring is needed.10
2. Baclofen
Baclofen is a muscle relaxant that acts as a GABA-B receptor agonist. It reduces excitability of spinal and brainstem neurons involved in the hiccup reflex.11 Adult dosing often starts very low (for example 5 mg three times daily) and is slowly increased, with a usual maximum around 80 mg per day according to FDA labeling.12 It has shown good results in many chronic singultus cases but can cause sleepiness, dizziness, and weakness.13
3. Gabapentin
Gabapentin is an anticonvulsant used for seizures and nerve pain.14 It is thought to calm over-active nerve firing in the hiccup pathway. Typical regimens for hiccups in reports use 300 mg three times daily, adjusted by the physician.15 Common side effects are dizziness, fatigue, and swelling of the legs. It is often combined with baclofen in difficult chronic cases.16
4. Metoclopramide
Metoclopramide is a pro-kinetic anti-nausea drug that increases movement of the upper gut and blocks dopamine receptors.17 Doses for persistent hiccups are often 10 mg up to four times daily, short term, under careful supervision.3 It can be especially helpful when gastroesophageal reflux or delayed stomach emptying is present. Side effects include restlessness, diarrhea, and with longer use, the risk of movement disorders.18
5. Proton pump inhibitors (PPIs, e.g., omeprazole)
PPIs strongly reduce stomach acid. They do not act directly on the diaphragm, but treating acid reflux, a frequent cause of chronic singultus, can stop hiccups in many people.1 Usual adult doses (such as 20–40 mg omeprazole once daily) are chosen by the doctor based on reflux severity. Side effects may include headache, diarrhea, and, with long-term use, altered mineral absorption.19
6. Haloperidol
Haloperidol is a potent antipsychotic that blocks dopamine receptors. Case reports show that small intramuscular or oral doses (for example 0.5–5 mg, carefully titrated) can rapidly stop intractable hiccups.20 It is often used when baclofen or gabapentin fail. Side effects include stiffness, tremor, agitation, heart rhythm changes, and sedation, so monitoring is essential.21
7. Amitriptyline
Amitriptyline is a tricyclic antidepressant that affects serotonin and norepinephrine and also has pain-modulating actions. Small bedtime doses may help in some hiccup cases, especially when nerve pain or mood symptoms are present.22 It can cause dry mouth, constipation, weight gain, and drowsiness, and it must be used carefully in people with heart disease.23
8. Valproic acid
Valproic acid is an anti-seizure medicine that stabilizes neuronal firing. It has stopped severe intractable hiccups in small case series, likely by treating diaphragm “myoclonus.”24 Dosing is individualized (often starting around 10–15 mg/kg/day), with blood tests to watch liver function and drug levels. Side effects include weight gain, tremor, and rare but serious liver or pancreas problems.25
9. Nifedipine
Nifedipine is a calcium-channel blocker usually used for high blood pressure. Small studies found that 30–60 mg per day helped some patients with intractable hiccups, possibly by relaxing smooth muscle and altering reflex arcs.26 Side effects may include low blood pressure, flushing, ankle swelling, and headache, so medical supervision is required.27
10. Midazolam
Midazolam is a short-acting benzodiazepine sedative. In hospital, very small intravenous doses may be used for severe refractory hiccups, especially when anxiety or procedures are triggers. It enhances GABA activity to calm central nervous system excitability. Side effects include drowsiness, breathing depression, and dependence risk, so it is for short monitored use only.23
11. Nimodipine
Nimodipine is another calcium-channel blocker mainly used to protect brain blood vessels. In a few reports it helped central causes of hiccups, probably by improving blood flow and modulating nerve activity. Doses and monitoring are similar to other calcium-channel blockers and must be supervised because of low blood pressure risk.23
12. Orphenadrine
Orphenadrine is a muscle relaxant with anticholinergic properties. It has been reported to improve intractable hiccups in some patients, likely by relaxing skeletal muscles and altering central reflex control. Side effects include dry mouth, blurred vision, and confusion, especially in older adults, so dose and duration are carefully limited.23
13. Cisapride (historical, restricted)
Cisapride is a strong pro-motility drug that used to be used for reflux and was reported to help hiccups by speeding stomach emptying.28 Because of serious heart rhythm side effects, its use has been heavily restricted or withdrawn in many places. It is mentioned here for completeness but is generally not used now.19
14. Domperidone (where available)
Domperidone is a peripheral dopamine-blocking anti-nausea medicine that improves gut motility. In some countries it has been tried for singultus linked to reflux or slow gastric emptying. It is less likely to cross into the brain, so may have fewer central nervous system effects, but can affect heart rhythm and must be prescribed carefully.22
15. Olanzapine
Olanzapine is an atypical antipsychotic. Very low doses have been used in some difficult hiccup cases, especially in palliative care, when other agents fail or are not tolerated.24 It blocks multiple receptors (dopamine, serotonin, histamine). Side effects include weight gain, sleepiness, and metabolic changes. It is reserved for selected patients.11
16. Corticosteroids (e.g., dexamethasone – rare special cases)
Steroids can cause hiccups, but rare reports describe dexamethasone helping when brain swelling triggers singultus.7 Because steroids have many serious side effects, they are not routine hiccup medicines and are only considered when there is a clear steroid-responsive underlying disease (for example, a brain tumor with swelling).7
17. H2-blockers (e.g., famotidine)
These medicines reduce stomach acid in a milder way than PPIs. When reflux or stomach irritation is thought to be the cause of singultus, doctors may use them alone or with other reflux medicines. Side effects are usually mild, such as headache or diarrhea, but they still need medical guidance.1
18. Antacids
Simple liquid or chewable antacids can neutralize stomach acid quickly. They are sometimes recommended as a first step while doctors investigate the cause, particularly if hiccups worsen after large meals or spicy foods.3 They are generally safe but can interact with other medicines and affect mineral balance if overused.4
19. Droperidol (specialist use)
Droperidol is a dopamine-blocking anti-nausea and sedative drug used in hospitals. Very low doses have been mentioned as alternatives for severe hiccups when other agents fail.24 Because it can disturb heart rhythm (QT prolongation), it is used only in carefully monitored settings.3
20. Combination therapy
In complex or cancer-related singultus, doctors may combine a reflux medicine (like a PPI) with baclofen, gabapentin, or other agents to target several parts of the reflex pathway at once.19 This is always individualized, based on other illnesses, kidney and liver function, and side-effect risks.23
Dietary molecular supplements (supporting general nerve and muscle health)
No supplement is a proven cure for singultus. These nutrients support nerve and muscle health in general and should only be used under professional guidance.
1. Magnesium
Magnesium is a key mineral for normal muscle contraction and nerve signaling.26 Low magnesium can cause muscle twitches and cramps. Correcting deficiency (often 200–400 mg per day of a well-absorbed form, as advised by a clinician) may reduce overall muscle irritability, including in the diaphragm. Too much magnesium, especially in kidney disease, can cause diarrhea, low blood pressure, or heart rhythm changes.26
2. Vitamin B6 (pyridoxine) – cautious dose
Vitamin B6 helps the body make neurotransmitters such as serotonin, dopamine, and GABA, which are vital for brain and nerve function.27 Modest doses within recommended dietary limits may support healthy nerve signaling. High-dose long-term supplements can damage nerves, so total daily intake should stay near normal dietary reference ranges, guided by a professional.28
3. B-complex (B1, B6, B12)
B1, B6, and B12 work together to support nerve repair, myelin health, and energy production.29 A balanced B-complex at standard doses (not mega-doses) may help people whose diet is low in these vitamins. Too much B6 can cause nerve injury, so supplement choices and doses should be checked with a doctor or dietitian.27
4. Omega-3 fatty acids (EPA/DHA)
Omega-3 fats from fish oil or algae have anti-inflammatory and neuro-protective effects and support cell membranes in the brain and nerves.30 Typical supplemental intakes are around 250–1000 mg combined EPA/DHA daily, adjusted individually. They may not directly stop hiccups but support overall nervous system health. Main side effects are fishy aftertaste and, at high doses, a slightly increased bleeding tendency.31
5. Probiotics
Probiotics are beneficial bacteria that support a healthy gut microbiome. The gut–brain axis means gut health can influence brain and nerve function.32 Standard daily doses depend on the product (often billions of CFU). They may help if reflux, bloating, or other gut issues are part of the singultus picture. Side effects are usually mild gas or bloating.33
6. Vitamin D
Vitamin D supports muscle and immune function. Many people are low in vitamin D, and correcting deficiency (dose chosen after a blood test) can improve general muscle strength and health. While not specific for hiccups, it helps overall resilience and is often part of long-term health plans.34
7. Coenzyme Q10
CoQ10 helps mitochondria (the “power stations” in cells) make energy, especially in muscles and nerves. Standard supplement doses are often 100–200 mg per day. It may support fatigue and muscle function in chronic illness, though evidence for hiccups specifically is lacking. It is usually well tolerated, with mild stomach upset in some people.35
8. L-theanine
L-theanine, a natural amino acid from tea, has calming effects on the nervous system and may reduce stress and improve sleep. Usual supplemental doses are 100–400 mg per day. By lowering anxiety and muscle tension, it might indirectly reduce hiccup triggers in some individuals.36
9. Curcumin (from turmeric)
Curcumin has anti-inflammatory and antioxidant actions. It is often given in enhanced-absorption forms at doses like 500–1000 mg per day in adults. It may support gut and nerve health indirectly by reducing inflammation. Main side effects are stomach discomfort or, rarely, gallbladder problems, especially at high doses.37
10. General multivitamin at standard dose
For people with poor diet, a simple once-daily multivitamin at normal recommended doses can correct small deficiencies in many vitamins and minerals needed for nerve and muscle function. This is safer than taking many high-dose single supplements and is often part of supportive care for chronic illness.34
Regenerative / stem-cell / “immunity booster” drugs in singultus
For singultus specifically, there are no approved stem-cell drugs or immune-boosting medicines used as standard treatment.1 In medical practice, regenerative or immune-modifying therapies are aimed at the underlying disease (for example, cancer, autoimmune disease), not at hiccups themselves.16
Doctors may use treatments such as corticosteroids, immunotherapy, or even stem-cell transplants to treat serious root causes like tumors or severe autoimmune illnesses. If hiccups improve after these treatments, it is because the underlying problem improved, not because the medicine directly targets the hiccup reflex. Any “stem-cell clinic” promising to directly cure hiccups should be viewed with great caution and discussed with a qualified specialist.21
Because of safety and ethics, detailed drug names and doses for stem-cell or strong immune drugs are not used for singultus self-management and always require specialist teams in hospital settings.
Surgical and interventional procedures (5)
1. Phrenic nerve block
In a phrenic nerve block, an anesthesiologist injects local anesthetic near the phrenic nerve in the neck or chest under imaging guidance. This temporarily interrupts nerve signals to the diaphragm and can stop intractable hiccups in selected patients, especially in advanced cancer.38
2. Temporary phrenic nerve clipping or crush (thoracoscopic surgery)
Surgeons can briefly clip or gently crush the phrenic nerve using minimally invasive chest surgery. This weakens diaphragm contractions on one side. Reports show relief of long-term hiccups, with clips sometimes removed later to allow recovery.39
3. Phrenic nerve or diaphragm pacing
In pacing, thin electrodes are placed to stimulate the diaphragm in a controlled pattern. This may help override chaotic spasms in very rare, severe singultus cases when other methods fail.40
4. Vagus nerve stimulation (VNS) implant
A VNS device is a small pulse generator placed under the skin of the chest, with a wire to the vagus nerve in the neck. Originally used for epilepsy, it has been tried in a few patients with chronic intractable hiccups. It aims to modulate the nerve pathways that trigger the hiccup reflex.7
5. Anti-reflux / stomach surgery (e.g., fundoplication)
When severe reflux or large hiatal hernia is driving chronic singultus and medicines fail, anti-reflux surgery such as Nissen fundoplication may be considered. By reducing acid and mechanical irritation of the esophagus and diaphragm, these operations can reduce hiccups in properly selected patients.1
Prevention tips (10)
Eat smaller, slower meals instead of large heavy ones.3
Limit fizzy drinks, very hot or cold drinks, spicy foods, and alcohol.3
Avoid swallowing a lot of air (for example, chewing gum for long periods).22
Do not lie flat straight after eating; wait at least two to three hours.1
Raise the head of the bed if reflux is a problem.
Manage long-term illnesses (diabetes, kidney disease, heart disease) with your healthcare team.
Review medicines with your doctor if hiccups start after a new drug (for example, some steroids or dopamine-acting drugs).1
Use healthy stress-management methods like walking, breathing exercises, or mindfulness.
Keep good sleep habits to reduce nervous system over-excitability.2
See a doctor early if hiccups last more than 48 hours instead of waiting many weeks.4
When to see a doctor
You should contact a doctor or clinic if hiccups last longer than 48 hours, keep coming back for many days, or disturb sleep, eating, or speaking.4 Seek urgent care if hiccups come with chest pain, severe headache, vomiting, weakness, trouble walking, confusion, or weight loss, because these can be signs of serious brain, heart, or gut problems.1
Doctors may do blood tests, chest and brain imaging, and other checks to find hidden causes. Early medical review helps treat the cause, prevent complications like poor sleep and dehydration, and choose the safest medicines or procedures for your situation.2
What to eat and what to avoid (10 key points)
Prefer small, frequent meals with soft, easy-to-digest foods to avoid sudden stomach stretching.3
Choose warm or room-temperature drinks instead of very hot or icy ones.
Include fiber-rich foods (vegetables, fruits, whole grains) to prevent constipation and bloating, which can irritate the diaphragm.
Limit very spicy foods, strong chili, and acidic foods if they trigger reflux or hiccups.
Reduce carbonated drinks like soda or sparkling water which increase stomach gas.
Keep alcohol intake low or avoid it, as it can irritate the stomach and nervous system.
Drink water regularly through the day, in small sips rather than large gulps.
Avoid very heavy, greasy meals late at night to reduce reflux.
Maintain a generally balanced diet with enough magnesium, B-vitamins, and omega-3 fats from foods such as leafy greens, nuts, whole grains, fish, and eggs.26
If you suspect a particular food always triggers your hiccups, keep a simple food diary and discuss it with your doctor or dietitian.
Frequently asked questions (15)
1. Are chronic hiccups dangerous by themselves?
Short hiccup attacks are usually harmless. Chronic singultus itself mainly causes tiredness, poor sleep, and difficulty eating. However, it can be a sign of a serious disease affecting the brain, chest, gut, or metabolism, which is why persistent or intractable hiccups should always be checked by a doctor.1
2. How long is “too long” to wait with hiccups?
If hiccups last more than 48 hours, come back very often, or worsen over time, you should arrange a medical review. If they last more than one month, they are called intractable and almost always need detailed evaluation.2
3. Can stress cause chronic singultus?
Stress does not usually cause singultus alone, but it can worsen it by speeding breathing, tightening muscles, and altering brainstem reflexes. Stress control and relaxation methods are helpful add-on treatments, especially when no clear physical trigger is found.7
4. Which medicine is usually tried first?
If reflux is suspected, doctors often start with acid-reducing medicines like PPIs or H2-blockers. For persistent hiccups without clear cause, current reviews suggest baclofen or gabapentin are reasonable first-line choices, with metoclopramide or chlorpromazine as second-line options.23
5. Why is chlorpromazine not always the first choice now?
Chlorpromazine is the only drug specifically licensed for intractable hiccups, but it can cause many side effects like low blood pressure and movement disorders, especially with long-term use.8 Because safer alternatives exist, many experts now keep it for later lines of treatment.11
6. Do home tricks like drinking water upside down really work?
Many popular tricks (drinking from the far side of a glass, sudden scares, or swallowing sugar) are harmless and sometimes work by changing breathing, swallowing, or vagus nerve stimulation. Scientific evidence is limited, but if a method is safe and your doctor agrees, it can be tried for mild attacks.5
7. Can children get chronic hiccups?
Children often have short hiccup episodes that resolve quickly. Persistent or intractable hiccups in a child are uncommon and should always be examined by a pediatric doctor to look for reflux, infections, nervous system problems, or medication effects.3
8. Are there tests specifically “for hiccups”?
There is no single “hiccup test.” Instead, doctors choose blood tests, chest X-ray, CT or MRI scans, endoscopy, or heart and brain tests depending on symptoms and risk factors. The aim is to find the underlying disease that is disturbing the hiccup reflex.1
9. Can chronic singultus be cured completely?
If the main cause (for example reflux, infection, or a certain medicine) is found and treated, hiccups often stop completely. In some complex brain or cancer conditions, they may not disappear fully but can usually be reduced with combined non-drug and drug treatment.7
10. Are chronic hiccups a sign of cancer?
Most people with hiccups do not have cancer. However, some cancers in the chest, brain, or upper abdomen can irritate the diaphragm or related nerves and cause persistent hiccups. Doctors consider this along with many other, more common causes during evaluation.1
11. Is surgery often needed for singultus?
No. Surgery or nerve procedures like phrenic nerve block or VNS are rare last-line options. They are considered only when all simpler measures, medicines, and cause-based treatments fail and when persistent hiccups severely affect quality of life.38
12. Can supplements alone treat chronic hiccups?
No supplement has strong proof that it can stop singultus by itself. Supplements may help correct deficiencies and support general nerve and muscle health, but they should be seen as supportive care alongside proper medical evaluation and treatment, not as a replacement.26
13. Do hiccups mean something is wrong with my brain?
Sometimes, but not usually. Brain lesions, strokes, infections, or multiple sclerosis can cause singultus, but many other non-brain causes (reflux, medicines, surgery, metabolic problems) are more common. Your doctor will look at your full story and exam to decide which tests are needed.1
14. Can lifestyle changes alone be enough?
For many people, especially when reflux, overeating, or stress are main triggers, lifestyle changes plus simple home measures can be enough. When hiccups are chronic, very strong, or linked to serious disease, lifestyle changes are still important but usually need to be combined with medical treatment.3
15. What is the most important step for someone with chronic singultus?
The most important step is not a single drug or trick. It is to see a doctor, share a clear history (when it started, what makes it better or worse, all medicines you use), and then follow a step-by-step plan that includes simple non-drug methods, careful use of medicines, and treatment of any underlying disease.2
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 24, 2026.
