Chronic hiccough (also spelled hiccough or singultus) means hiccups that go on for a long time and do not stop in the usual few minutes. Doctors often use the word persistent hiccups when they last more than 48 hours, and intractable hiccups when they continue for more than one month.
Chronic hiccough (often written “chronic hiccups”) means hiccups that last a long time and keep coming back. Doctors usually call them “persistent” if they last more than 48 hours and “intractable” if they last more than 1–2 months. These long-lasting hiccups can disturb sleep, eating, talking, and mental health, and they can be a sign of another serious health problem, such as reflux disease, nerve damage, lung disease, brain disease, or certain medicines. The basic problem is a repeated, sudden spasm of the diaphragm (breathing muscle) and nearby nerves, which makes air rush into the lungs and the voice box close quickly, causing the “hic” sound.
A hiccough is an involuntary, sudden spasm of the diaphragm muscle (the large breathing muscle under the lungs). This spasm pulls air quickly into the chest, and then the vocal cords close, making the “hic” sound. Hiccoughs use a reflex arc that includes nerves in the chest, neck and brain (vagus nerve, phrenic nerve, and parts of the brainstem). When this reflex is irritated or damaged for a long time, the hiccoughs can become chronic and may be the only sign of a serious underlying disease.
Chronic hiccough can disturb sleep, eating, drinking, wound healing, and even breathing, and it often causes strong stress, anxiety, and embarrassment. Because of this, long-lasting hiccoughs are not just a “funny” symptom; they need careful medical evaluation.
Other names for chronic hiccough
Doctors and books use several different names for the same problem:
Chronic hiccough is also called chronic hiccup, singultus, persistent hiccups, intractable hiccups, and sometimes synchronous diaphragmatic flutter (SDF). All of these terms describe repeated, unwanted diaphragm spasms causing the classic “hic” sound, especially when they last more than 48 hours.
Types of hiccough
Chronic hiccough can be grouped in different ways. One simple way is by how long it lasts:
Acute or transient hiccough
This type lasts only a few minutes or a few hours and then stops by itself. It is usually caused by simple triggers like eating too fast, drinking fizzy drinks, or laughing a lot. It is common and usually harmless.Persistent hiccough
Persistent hiccough is usually defined as hiccups that stay for more than 48 hours. At this stage, doctors worry more about underlying problems such as stomach disease, lung disease, brain disease, or medicines.Intractable hiccough
Intractable hiccough continues for more than one month without stopping. It can cause serious problems like weight loss, severe tiredness, malnutrition, and mood changes. Intractable hiccough almost always needs full medical work-up and active treatment.Central nervous system–related hiccough
In this type, the main cause sits in the brain or spinal cord, for example stroke in the brainstem, multiple sclerosis, brain tumors, or inflammation around the medulla. These problems can disturb the hiccough reflex in the central nervous system.Peripheral / metabolic / systemic hiccough
Here the cause is outside the brain, such as diseases of the stomach, lungs, kidneys, or blood chemistry (electrolytes), or certain drugs. These conditions irritate the vagus nerve, phrenic nerve, or diaphragm and keep the reflex over-active.Psychogenic or functional hiccough
In some patients, no clear physical cause is found, and stress, anxiety, or psychological factors may play a role. Doctors usually make this diagnosis only after looking for medical and neurological causes.
Causes of chronic hiccough
Many different problems can irritate the hiccough reflex and lead to chronic episodes. Often, more than one factor is present in the same patient.
Gastroesophageal reflux disease (GERD)
GERD happens when stomach acid repeatedly flows back into the food pipe (esophagus). This acid can irritate nerves near the diaphragm and trigger long-lasting hiccoughs; GERD is reported as one of the most common causes of persistent hiccups.Esophagitis, gastritis, or peptic ulcer disease
Inflammation or ulcers in the esophagus or stomach can stimulate sensory nerves that are linked to the hiccough reflex. Patients may have heartburn or upper belly pain along with the hiccoughs.Hiatal hernia
In a hiatal hernia, part of the stomach slides up into the chest. This can change the position of the diaphragm and increase reflux, which may irritate the phrenic nerve and cause repeated hiccoughs.Pancreatitis or other upper abdominal inflammation
Swelling of the pancreas or nearby organs sends pain and irritation signals through nerves that share pathways with the hiccough reflex, sometimes causing stubborn hiccups.Liver or gallbladder disease
Enlarged liver, gallbladder inflammation, or tumors in the upper abdomen can push on the diaphragm and disturb its movement, leading to chronic hiccough in some patients.Pneumonia and other lung infections
Infection in the lungs, especially near the diaphragm, can inflame the pleura (lining of the lungs) and stimulate the phrenic nerve, resulting in persistent hiccough.Pulmonary embolism or pleurisy
A blood clot in the lungs or inflammation of the pleural lining can cause chest pain and irritate nerves that take part in the hiccough reflex; in rare cases, persistent hiccough can be an early sign of these serious conditions.Mediastinal or intrathoracic tumors
Tumors in the chest (for example in the mediastinum, lungs, or around the esophagus) can compress the vagus nerve, phrenic nerve, or diaphragm. This mechanical irritation may cause chronic, hard-to-treat hiccough.Stroke, especially brainstem (lateral medullary) stroke
Damage to the brainstem where the hiccough reflex is controlled, such as Wallenberg syndrome (lateral medullary infarct), is a well-known cause of prolonged singultus.Brain tumors or central nervous system lesions
Tumors, multiple sclerosis plaques, infections, or trauma affecting the brain or upper spinal cord can disturb the central part of the reflex arc and lead to intractable hiccough.Metabolic problems such as uremia (kidney failure)
When kidneys fail and waste products build up in the blood, or when electrolytes like sodium and calcium are abnormal, the nervous system becomes irritable, which can trigger chronic hiccough.Electrolyte abnormalities (hypocalcemia, hyponatremia, etc.)
Low calcium, low sodium, and other electrolyte changes can change nerve and muscle function, sometimes presenting as persistent hiccups together with cramps or confusion.Diabetes and high blood sugar
Poorly controlled diabetes can damage nerves (neuropathy) and change metabolism. Chronic hiccough may rarely appear in association with diabetic complications, so blood sugar checks are part of the work-up.Infections such as influenza, herpes zoster, or other systemic infections
Viral or bacterial infections can inflame nerves or organs in the chest and abdomen, occasionally presenting with persistent hiccups along with fever and malaise.Medicines (drug-induced hiccough)
Several medicines are linked to chronic hiccough, including dopamine agonists, low-dose benzodiazepines, some chemotherapy drugs, dexamethasone, and certain antibiotics such as azithromycin. Doctors always review the medicine list when hiccups do not stop.Recent surgery and general anesthesia
Operations, especially in the chest or upper abdomen, and use of general anesthesia can irritate the diaphragm or change stomach function, sometimes causing days or weeks of hiccough after the procedure.Cardiac conditions including myocardial infarction (heart attack)
In rare cases, persistent hiccough can be a warning sign of heart attack or other heart disease, likely due to irritation of nearby nerves or the diaphragm.Toxic exposures and alcohol use
Alcohol and some toxic substances affect the brain and peripheral nerves and can induce long-lasting hiccups, especially in people with heavy use or withdrawal.Psychological stress and anxiety
Emotional stress does not damage the diaphragm directly but can make the nervous system more sensitive. In some patients, chronic hiccough is linked with anxiety, and symptoms may worsen during stressful periods.Idiopathic (no clear cause found)
Even after many tests, a clear cause is not found in some cases. These are called idiopathic chronic hiccough. Doctors still treat symptoms and may give anti-reflux or nerve-acting medicines, but they explain that no definite trigger has been identified.
Symptoms of chronic hiccough
Chronic hiccough causes more than just the “hic” sound. It can affect almost every part of daily life.
Repeated, unstoppable hiccoughs
The main symptom is frequent, rhythmic hiccoughs that continue for more than 48 hours and may come in long bouts during the day and night.Trouble sleeping (insomnia)
Constant hiccoughs can wake the person again and again at night, making sleep short and poor in quality. Over time, this leads to daytime sleepiness.Tiredness and exhaustion
Because the body is always “jerking” with each hiccup and sleep is disturbed, patients often feel extremely tired, weak, and worn out.Difficulty eating and drinking
Hiccoughs can interrupt swallowing and chewing. Some people choke easily or feel afraid to eat, which can lead to poor intake of food and fluids.Weight loss and malnutrition
When eating is hard for many days or weeks, people may lose weight and become malnourished. This makes the body weaker and slows healing.Chest discomfort or pain
Repeated strong contractions of the diaphragm and chest wall muscles can cause soreness or pain in the chest or upper abdomen.Abdominal pain or bloating
Swallowed air and spasms may cause a feeling of fullness, bloating, or pain in the upper belly, especially if the cause is a stomach or esophagus problem.Heartburn or sour taste in the mouth
If GERD is present, there may be burning pain behind the breastbone, sour fluid in the mouth, or a feeling of food coming back up.Nausea and vomiting
Some patients feel sick to the stomach or vomit, especially when the cause involves the stomach, liver, pancreas, or brain.Shortness of breath or disturbed breathing
Very rapid or strong hiccups can interfere with normal breathing, especially in people already weak from other illness, and can cause feelings of breathlessness.Wound problems after surgery
In patients who recently had an operation, constant jerking of the abdominal muscles can pull on stitches and may delay healing or even cause wound separation.Difficulty speaking and social embarrassment
The “hic” sound can break up speech and make conversation hard or embarrassing in public places, leading some people to avoid social situations.Poor concentration and reduced quality of life
Ongoing hiccoughs and poor sleep make it hard to focus on work, school, or reading, and many patients describe a major drop in daily quality of life.Anxiety, irritability, or depressed mood
Living with constant involuntary sounds and movements can make people feel anxious, frustrated, or low in mood, especially when treatments have not worked yet.Complications from underlying disease
Sometimes the symptoms of the disease causing the hiccoughs (such as stroke signs, chest pain, or severe heartburn) are present together with the hiccoughs and may be more dangerous than the hiccough itself.
Diagnostic tests for chronic hiccough
Doctors choose tests based on the history and examination. The main goal is to find or rule out serious causes, especially in the brain, chest, abdomen, or metabolism.
Physical exam tests
General examination and vital signs
The doctor looks at the patient’s overall appearance and checks pulse, blood pressure, temperature, breathing rate, and oxygen level. Fever, low oxygen, or unstable blood pressure can point to infection, lung disease, or other serious causes of hiccough.Head and neck examination
The doctor inspects the mouth, throat, and neck, checking for enlarged lymph nodes, thyroid enlargement, or masses that could press on the vagus nerve and contribute to persistent hiccups.Chest and lung examination
Listening with a stethoscope and tapping on the chest help detect pneumonia, fluid, or other changes in the lungs and pleura that may irritate the diaphragm and nerves.Abdominal examination
The doctor gently presses on different areas of the abdomen and listens for bowel sounds to look for tenderness, enlarged liver, masses, or distended stomach, which can suggest GERD, pancreatitis, tumors, or other abdominal causes.Basic neurological examination
A focused neurological exam checks limb strength, reflexes, coordination, eye movements, and facial muscles. Any focal weakness, abnormal reflex, or balance problem may suggest a stroke or other central nervous system cause behind the hiccoughs.
Manual / bedside tests
Cranial nerve testing (bedside)
The doctor tests the cranial nerves by asking the patient to follow a finger with their eyes, smile, puff out cheeks, move the tongue, and shrug the shoulders. Changes in these functions may point toward brainstem or nerve lesions linked with chronic singultus.Gag reflex and palate movement test
Touching the back of the throat to check the gag reflex and watching the soft palate move helps evaluate glossopharyngeal and vagus nerve function; abnormal findings may indicate neurologic disease affecting the hiccough arc.Swallowing assessment
The clinician may observe the patient swallowing water or semi-solid foods to see if there is choking, coughing, or food sticking. Difficulty swallowing (dysphagia) suggests esophageal disease or neurologic problems that may also cause chronic hiccough.Posture and musculoskeletal assessment
The doctor may examine the spine, ribs, and chest wall movement and ask the patient to take deep breaths. Abnormal posture or restricted chest movement can contribute to diaphragm irritation and may hint at underlying lung or skeletal disease.Mental status and mood check
A brief bedside check of orientation, memory, and mood can detect confusion, anxiety, or depression, which may be related to brain disease or psychogenic hiccough and help guide further testing.
Lab and pathological tests
Complete blood count (CBC)
A CBC looks at red cells, white cells, and platelets. It can show infection, anemia, or blood diseases that might be connected to lung, abdomen, or systemic illnesses causing chronic hiccough.Serum electrolytes (sodium, potassium, calcium, magnesium)
These blood tests check basic salts and minerals. Abnormal levels, such as low sodium or low calcium, can make nerves and muscles more excitable and are recognized as possible triggers for persistent hiccups.Kidney and liver function tests
Blood tests like creatinine, urea, and liver enzymes look for uremia and liver disease. These metabolic problems can lead to hiccough through toxin build-up or organ enlargement.Blood glucose and HbA1c
Measuring blood sugar and long-term glucose control helps detect diabetes. Since diabetes can affect nerves and metabolism, identifying and treating it is important in chronic hiccough work-up.Inflammatory markers and infection tests (CRP, ESR, cultures)
Raised inflammatory markers or positive cultures can point toward infection or inflammatory disease in the lungs, abdomen, or other sites that may explain persistent hiccups.
Electrodiagnostic tests
Electrocardiogram (ECG)
An ECG records the heart’s electrical activity. It helps rule out heart attack or other arrhythmias when chest pain or cardiac risk factors are present alongside chronic hiccough.Electromyography (EMG) of the diaphragm or phrenic nerve studies (specialized)
In rare, complex cases, nerve conduction tests and EMG can assess how well the phrenic nerve and diaphragm muscle are working and detect neuropathy or muscle disease linked with intractable hiccough.Electroencephalogram (EEG) when seizures are suspected
If there are signs of seizures or episodic abnormal movements, an EEG may be used to see if brain electrical activity shows epilepsy that could mimic or trigger hiccough-like movements.
Imaging and endoscopic tests
Chest X-ray
A chest X-ray is often one of the first imaging tests. It can show pneumonia, lung masses, enlarged heart, diaphragm elevation, or other changes that could irritate the hiccough pathway.CT or MRI of head, chest, and abdomen
CT and MRI scans provide detailed pictures of the brain, brainstem, chest, and abdomen. They can detect strokes, tumors, structural abnormalities, and other serious causes of chronic hiccough that are not visible on plain X-ray.Upper gastrointestinal endoscopy
In this test, a flexible tube with a camera is passed through the mouth into the esophagus and stomach to look for esophagitis, ulcers, hiatal hernia, or tumors. Endoscopy is especially important when GERD or upper GI disease is suspected as the driver of persistent hiccough.CT or MRI specifically targeting brainstem and cervical spinal cord
Focused imaging of the medulla and upper spinal cord can reveal small strokes, demyelinating lesions, or tumors exactly where the hiccough reflex center lies, helping to explain otherwise unexplained intractable singultus.Thoracic and abdominal CT for hidden masses or inflammation
CT of the chest and abdomen helps detect mediastinal tumors, enlarged lymph nodes, pancreatic disease, and other hidden causes that may not be obvious on exam but are known to cause chronic hiccough.
Non-pharmacological treatments (therapies and other methods)
1. Slow diaphragmatic breathing practice
A very simple but powerful therapy is slow, deep breathing using the diaphragm. The person sits upright, puts a hand on the upper belly, and slowly breathes in through the nose so the belly rises, then breathes out gently through pursed lips. Doing this for a few minutes can calm the hiccup reflex. The purpose is to reset breathing rhythm and reduce sudden diaphragm spasms. The mechanism is that stable, controlled breathing changes carbon dioxide levels and reduces over-excited signals in the phrenic and vagus nerves that control the diaphragm and voice box.
2. Breath-holding and gentle Valsalva maneuver
Another home therapy is to take a deep breath and hold it for as long as is comfortable, or to bear down gently as if trying to blow out with the mouth closed (Valsalva maneuver). The purpose is to interrupt the hiccup cycle. The mechanism is that breath-holding and gentle strain increase pressure in the chest and stimulate the vagus nerve, which can “reset” the reflex arc that is causing the hiccups. This should be done carefully and avoided in people with heart or eye problems unless a doctor advises it.
3. Sipping cold water slowly
Sipping cold water in small, repeated swallows is a classic non-drug method. The purpose is to give a steady, mild stimulation to the throat and esophagus, which can distract and reset the hiccup reflex. The mechanism is that cold temperature and repeated swallowing send new signals through the glossopharyngeal and vagus nerves, which may override the abnormal firing that causes diaphragm spasms. It is safer to sip slowly instead of gulping large amounts at once.
4. Gargling with cold water
Gargling with cold water is similar to sipping but gives stronger stimulation to the back of the throat. The purpose is to activate sensory nerves around the soft palate and pharynx. The mechanism is that this strong, brief nerve input may interrupt the hiccup reflex pathway in the brainstem. It is an easy, low-risk method and can be repeated several times, as long as the person does not choke.
5. Breathing into a paper bag (with care)
Some adults use slow breathing into a paper bag for a short time. The purpose is to gently increase carbon dioxide in the blood, which may calm the breathing control center. The mechanism is that higher carbon dioxide can reduce over-excitability in the nerves and muscles involved in hiccups. This method must not be used in children, people with heart or lung disease, or for long periods, and never with plastic bags, because of the risk of low oxygen. Always ask a doctor first.
6. Swallowing sugar or a small piece of dry bread
Some people get relief by swallowing a teaspoon of granulated sugar or a small piece of dry bread. The purpose is to give a strong but brief mechanical and taste stimulation inside the mouth and throat. The mechanism is that this sudden sensory input can interfere with the hiccup reflex arc. People with diabetes, swallowing problems, or choking risk should avoid this or try safer options like cold water instead.
7. Posture correction and sitting upright after meals
Sitting upright during and after meals, avoiding lying flat soon after eating, and keeping the head slightly elevated can help some chronic hiccup patients. The purpose is to reduce reflux and pressure on the diaphragm. The mechanism is that better posture lowers stomach pressure against the diaphragm and reduces irritation of the nerves that control it. This is especially helpful if chronic hiccups are linked to acid reflux or bloating.
8. Small, frequent meals instead of large heavy meals
Eating smaller meals more often, chewing slowly, and avoiding overeating can reduce triggers. The purpose is to prevent the stomach from becoming overly full, which can stretch the diaphragm and trigger hiccups. The mechanism is that less distension of the stomach leads to fewer abnormal signals to the diaphragm and vagus nerve. This approach also helps people with reflux or delayed stomach emptying.
9. Avoiding trigger foods and drinks
Spicy foods, very hot or cold foods, carbonated drinks, and alcohol are common hiccup triggers. The purpose of avoiding them is to reduce irritation of the esophagus and stomach. The mechanism is that less chemical and temperature irritation means fewer abnormal reflex signals to the diaphragm. People with chronic hiccups are often advised to keep a food diary and see which items seem to make symptoms worse.
10. Relaxation training and stress management
Stress, anxiety, and sudden emotional changes can make hiccups worse for some people. Relaxation methods like mindfulness, gentle yoga, or guided breathing can help. The purpose is to lower overall nervous system arousal. The mechanism is that calming the autonomic nervous system reduces the chance of sudden nerve firing in the hiccup reflex pathway. Over time, this may lessen the frequency and severity of chronic hiccups.
11. Gentle neck and upper-back stretching
Tight muscles around the neck and upper chest can sometimes irritate nearby nerves. Gentle stretching and posture exercises under the guidance of a physiotherapist may help. The purpose is to relieve muscle tension around the path of the phrenic nerve. The mechanism is that improved muscle balance and posture may reduce mechanical irritation of the nerve fibers that go from the neck to the diaphragm.
12. Targeted physiotherapy for the diaphragm
Some patients benefit from exercises supervised by a physiotherapist that focus on strengthening and relaxing the diaphragm and chest wall. The purpose is to improve control of the breathing muscles. The mechanism is that better neuromuscular coordination may reduce unwanted spasms and make each hiccup episode shorter. This is often used in people with lung disease or after surgery.
13. Acupressure or acupuncture (specialist-led)
In some reports, acupressure or acupuncture at specific points (for example, near the wrist or neck) has helped intractable hiccups. The purpose is to modulate nerve activity through stimulation of specific points on the body. The mechanism is not fully clear, but it may involve endorphin release and changes in central nervous system processing of the hiccup reflex. This should only be done by trained practitioners and alongside medical care.
14. Nasopharyngeal stimulation (doctor-performed)
Old case reports describe gently stimulating the back of the nose and throat with a catheter or similar tool in a medical setting. The purpose is to give a strong stimulus to nerves in the nasopharynx. The mechanism is that such stimulation can interrupt the hiccup reflex, similar to “resetting” a stuck switch. Because of discomfort and risk, this is not a home method and is rarely used now.
15. Using a special “hiccup straw” device
A commercial device (for example, HiccAway®) is designed like a straw with a small opening that forces people to suck harder when drinking. The purpose is to create strong negative pressure and then rapid swallowing. The mechanism is that this combination strongly activates the diaphragm and vagus nerve in a controlled way, which can stop a hiccup episode in some people. It is non-drug and generally low risk.
16. Sleep hygiene and regular routines
Poor sleep and irregular routines can make chronic symptoms, including hiccups, feel worse. Good sleep habits (fixed bedtime, quiet dark room, limiting screens) can support overall nervous system balance. The purpose is to reduce fatigue and stress. The mechanism is indirect: better sleep stabilizes brain and nerve function, which may reduce the frequency of reflex misfires like hiccups.
17. Psychological support or counseling
Long-lasting hiccups can cause embarrassment, anxiety, and even depression. Talking therapies or counseling can help people cope. The purpose is emotional support and stress reduction, which may indirectly ease symptoms. The mechanism is that lower anxiety means less sympathetic nervous system activation, which may reduce triggers for the hiccup reflex.
18. Treating acid reflux with lifestyle changes
Chronic hiccups are often linked with gastroesophageal reflux disease (GERD). Non-drug steps like raising the head of the bed, avoiding food 2–3 hours before sleep, losing excess weight, and avoiding tight clothing can help. The purpose is to reduce acid flowing back into the esophagus. The mechanism is that less reflux means less irritation of nerves that can trigger hiccups.
19. Treating constipation and bloating
Constipation and gas can increase abdominal pressure and push up on the diaphragm. Managing bowel habits with fiber, fluids, and gentle activity can help. The purpose is to reduce distension of the bowel and stomach. The mechanism is that less mechanical pressure means fewer abnormal signals to the diaphragm and its nerves, which may reduce hiccups.
20. Combined step-wise approach under medical guidance
For many people, no single therapy is enough. Doctors often suggest combining several non-drug methods, like breathing exercises, posture changes, reflux control, and stress reduction, while they also search for underlying disease. The purpose is to attack the problem from several angles at once. The mechanism is that each method addresses one part of the hiccup reflex, so together they have a stronger effect.
Drug treatments for chronic hiccough
Very important: Most of these medicines are prescription-only and can have serious side effects. Doses below are general adult ranges from official labels and reviews, not personal advice. A doctor must decide if any drug is safe and suitable for a specific person.
1. Chlorpromazine
Chlorpromazine is a first-generation antipsychotic and is the only FDA-approved medicine specifically labeled for intractable hiccups. For this use, labels describe oral doses around 25–50 mg three or four times daily; if symptoms persist 2–3 days, injections may be used in hospital. The purpose is to calm the hiccup center in the brain. The mechanism is dopamine receptor blockade in the brainstem, which reduces abnormal reflex firing. Side effects can include drowsiness, low blood pressure, dry mouth, movement disorders, and rare serious reactions, so close monitoring is needed.
2. Baclofen
Baclofen is a muscle relaxant that acts on GABA-B receptors and is FDA-approved for spasticity. In studies and case reports, oral baclofen (for example, 5–10 mg three times daily, adjusted by doctors) has improved persistent or intractable hiccups. The purpose is to reduce over-activity of the diaphragm and related nerves. The mechanism is enhancement of inhibitory GABA signals in the spinal cord and brainstem, which calms the hiccup reflex. Side effects may include sleepiness, dizziness, weakness, and, with sudden stop, withdrawal symptoms; any dose change must be gradual under medical supervision.
3. Gabapentin
Gabapentin is an anticonvulsant and neuropathic pain medicine that modulates calcium channels in nerves. Doctors sometimes use it off-label for chronic hiccups, often starting at low doses like 100–300 mg three times daily and adjusting as needed. The purpose is to stabilize nerve activity in the hiccup reflex arc. The mechanism is binding to α2δ subunits of voltage-gated calcium channels, reducing excitatory neurotransmitter release. Side effects can include dizziness, tiredness, swelling of legs, and mood changes. Because it affects the brain, it must be used with caution and medical follow-up.
4. Metoclopramide
Metoclopramide is a pro-kinetic and anti-nausea drug that increases stomach emptying and blocks dopamine receptors. It is licensed for problems like nausea and slow stomach emptying but has also been used off-label for hiccups, often 10 mg up to four times daily for short periods. The purpose is to treat reflux or stomach problems that may trigger hiccups and to act directly on the brainstem. The mechanism includes dopamine blockade and increased gastrointestinal motility. Side effects can be serious, such as movement disorders (tardive dyskinesia), restlessness, and sleepiness, so long-term use is limited and doctor monitoring is essential.
5. Haloperidol
Haloperidol is another potent dopamine-blocking antipsychotic sometimes used off-label for severe hiccups when other drugs fail. Typical adult doses for psychiatric use are low (for example, 0.5–5 mg two or three times daily), and hiccup doses are often in the lower range, decided by the doctor. The purpose is to strongly dampen the hiccup center in the brain. The mechanism is dopamine D2 receptor blockade. Side effects include marked sedation, movement disorders, heart rhythm changes, and other serious risks, so it is usually reserved for hospital or specialist care.
6. Nifedipine
Nifedipine is a calcium channel blocker mainly used for high blood pressure and chest pain. Some reports describe low-dose nifedipine for stubborn hiccups, generally as a specialist off-label choice. The purpose is to relax smooth muscle and possibly reduce excitability in the diaphragm and blood vessels supplying the reflex pathway. The mechanism is blocking L-type calcium channels. Side effects may include flushing, headache, ankle swelling, and low blood pressure, and it interacts with other heart drugs, so only a cardiology-aware doctor should consider it.
7. Valproate (divalproex sodium)
Valproate is an antiepileptic and mood stabilizer. In some cases, especially when chronic hiccups are linked with brain disease or seizures, it has been used off-label. Adult doses vary widely (for example, starting 10–15 mg/kg/day and adjusting), and levels are often monitored with blood tests. The purpose is to stabilize brain activity. The mechanism includes increased GABA levels and effects on sodium and calcium channels. Side effects can be serious: liver toxicity, weight gain, tremor, and birth defects, so it must never be used without strict medical indication and monitoring.
8. Phenytoin and other anticonvulsants
Older case reports describe phenytoin and similar anticonvulsants helping some patients with intractable hiccups, especially when seizures or brain lesions are present. The purpose is to control abnormal electrical activity in the brain. The mechanism is mainly sodium channel modulation, which stabilizes neurons in the hiccup pathway. Side effects include gum problems, unsteady walking, rash, and serious allergic reactions, and drug levels must be monitored. Because of risks and better alternatives, these drugs are now rarely used for hiccups and only by specialists.
9. Proton pump inhibitors (PPIs) such as omeprazole
PPIs reduce stomach acid and are commonly used when reflux or esophagitis seems to be causing hiccups. Doses might be 20–40 mg once or twice daily, as prescribed. The purpose is to heal acid damage and reduce reflux events that trigger hiccups. The mechanism is blocking the proton pump in stomach cells, which lowers acid production. Side effects can include headache, diarrhea, and, with long-term use, changes in mineral absorption. PPIs do not directly stop hiccups but help by treating an important trigger.
10. Other reported medicines (briefly)
Other drugs mentioned in case series include benzodiazepines (like midazolam), local anesthetics (like lidocaine), certain antidepressants, and opioids in palliative care. These are usually last-line options in hospital, chosen for complex patients with cancer or severe disease. Their purpose is often symptom relief rather than cure, and mechanisms vary (sedation, pain control, nerve blocking). Because these medicines can depress breathing and cause dependence or serious side effects, they are used only under very close specialist supervision.
Dietary molecular supplements
Evidence for supplements in chronic hiccups is limited. They may help underlying problems (like reflux, nerve health, stress), but they do not replace medical evaluation.
1. Magnesium
Magnesium is a mineral that helps muscles and nerves work properly. If a person is low in magnesium, muscles (including the diaphragm) can spasm more easily. A typical supplement dose for adults is often 200–400 mg elemental magnesium per day, adjusted by a doctor. The purpose is to support normal neuromuscular function. The mechanism is stabilization of nerve cell membranes and regulation of calcium flow in muscle fibers. Too much can cause diarrhea, low blood pressure, or heart rhythm changes, especially in kidney disease, so medical advice is important.
2. Vitamin B complex (B1, B6, B12)
B-vitamins are important for nerve health and energy metabolism. Some chronic hiccup causes, like neuropathy or malnutrition, may be linked to low B-vitamins. Typical doses vary (for example, B-complex tablets once daily), chosen by a doctor or dietitian. The purpose is to support repair and proper function of nerves in the hiccup reflex arc. The mechanism is involvement in myelin formation and neurotransmitter synthesis. Side effects are usually mild but high doses of certain B-vitamins can cause nerve problems, so mega-dosing is not safe.
3. Omega-3 fatty acids (fish oil or algae oil)
Omega-3s have anti-inflammatory and nerve-protective properties. A common adult dose for general health is around 500–1000 mg/day of EPA+DHA, though doctors may suggest different amounts. The purpose in chronic hiccups is indirect: to support nerve and brain health and reduce inflammation in conditions that might trigger hiccups. The mechanism involves changes in cell membranes and inflammatory pathways. Side effects can include fishy aftertaste and, at high doses, increased bleeding risk, especially with blood thinners.
4. Melatonin
Melatonin is a hormone that helps regulate sleep and is also a mild antioxidant. For adults, 1–5 mg at night is a common range, but the lowest effective dose is preferred. The purpose is to improve sleep and reduce nighttime stress, which may indirectly calm chronic hiccups. The mechanism involves melatonin receptors in the brain and its antioxidant effects. Side effects can include vivid dreams, morning grogginess, and interactions with other sedative drugs.
5. Probiotic supplements
Probiotics are “good bacteria” that support gut health. Doses are usually given as colony-forming units (for example, 1–10 billion CFU/day), selected by strain. The purpose is to balance gut flora, which can reduce gas, bloating, and reflux—common hiccup triggers. The mechanism is improved digestion, better barrier function, and modulation of gut immune responses. Most healthy people tolerate probiotics well, but very ill or immunocompromised patients should ask doctors first.
6. Ginger extract
Ginger has long been used for nausea and digestion. Standardized extract capsules often contain the equivalent of 500–1000 mg of dried ginger daily, but doses vary. The purpose is to support stomach emptying and reduce nausea and reflux that can worsen hiccups. The mechanism includes effects on gut motility and serotonin receptors. Side effects may include heartburn or stomach upset in some people and possible interaction with blood thinners.
7. Curcumin (from turmeric)
Curcumin is an anti-inflammatory compound from turmeric. Typical supplement doses range from 500–1000 mg/day with added pepper extract to improve absorption. The purpose is to reduce inflammation in conditions like reflux, liver disease, or systemic illnesses that may be associated with hiccups. The mechanism involves modulation of inflammatory pathways and antioxidant effects. Side effects can include stomach upset or gallbladder issues in some people.
8. L-theanine
L-theanine is an amino acid found in tea that promotes relaxation without strong sedation. Common supplement doses are 100–200 mg once or twice daily. The purpose is to reduce anxiety and stress that may trigger hiccups. The mechanism is modulation of brain neurotransmitters such as GABA and glutamate. Side effects are usually mild, like headache or sleep changes, but long-term safety data are limited, so it should be used carefully.
9. Coenzyme Q10 (CoQ10)
CoQ10 helps cells produce energy and has antioxidant effects. Doses for general support are often 100–200 mg daily, taken with food. The purpose is to support muscle and nerve energy metabolism, especially if underlying heart or neurologic disease is present. The mechanism involves mitochondrial function and free-radical scavenging. Side effects can include stomach upset or insomnia in some people.
10. General multivitamin/mineral supplement
For people with poor nutrition or chronic illness, a balanced multivitamin/mineral can help correct small deficiencies. Dosing follows the product label, usually once daily. The purpose is broad support of metabolism, immune function, and nerve health. The mechanism is replacement of vitamins and minerals needed for normal nerve, muscle, and organ function. While generally safe, megadoses are not recommended, and people with kidney or liver disease must ask a doctor before use.
Drugs for immunity / regenerative support and stem-cell-type approaches
At this time, there are no specific FDA-approved “immunity-booster,” “regenerative,” or stem-cell drugs that are proven and approved just for chronic hiccups. Chronic hiccough is usually treated by:
Finding and treating the underlying disease (for example, infection, stroke, tumor, reflux, kidney failure).
Using medicines like chlorpromazine, baclofen, gabapentin, or metoclopramide when needed.
Experimental work in other diseases looks at nerve-protective drugs and stem-cell therapies, but these are not standard care for hiccups and should only be done in research settings under strict specialist and ethics control. It would not be safe or honest to list “immune booster stem-cell drugs” for chronic hiccups because good evidence is not available.
Surgical and interventional procedures
1. Phrenic nerve block
In tough cases that do not respond to medicines, doctors may temporarily block the phrenic nerve (the main nerve to the diaphragm) using an injection of local anesthetic under ultrasound guidance. The purpose is to interrupt the nerve signals that cause diaphragm spasms. The mechanism is reversible nerve blockade, often giving short-term relief. Risks include breathing weakness on the treated side and rare injury to nearby structures, so it is done only by trained specialists in a monitored setting.
2. Phrenic nerve clipping or surgical interruption
For extremely severe, disabling hiccups, surgeons may use minimally invasive surgery to temporarily clip or interrupt the phrenic nerve. The purpose is longer-lasting interruption of the reflex pathway when all other therapies fail. The mechanism is partial or complete block of nerve impulses to the diaphragm, which stops spasms on that side. Because it can weaken breathing and has surgical risks, it is reserved for very rare cases after careful discussion.
3. Vagus nerve stimulation (VNS)
Vagus nerve stimulation devices are usually used for epilepsy or depression, but case reports show they can help chronic intractable hiccups when other methods fail. A small pulse generator is implanted under the skin and connected to the vagus nerve in the neck. The purpose is to modulate brain and nerve activity in the hiccup reflex arc. The mechanism is regular electrical stimulation that changes how signals are processed in the brainstem. Risks include hoarseness, cough, infection, and need for surgery.
4. Diaphragmatic pacing
In some complex cases, especially in people with spinal cord problems, diaphragmatic pacing (electrical stimulation of the diaphragm to support breathing) has been used along with treatments for hiccups. The purpose is to give controlled diaphragm movement and sometimes reduce unwanted spasms. The mechanism is electrical activation of the muscle via implanted electrodes. This is a major intervention and is generally used for breathing support rather than for hiccups alone.
5. Surgery for underlying disease
Sometimes the best “surgical” treatment for chronic hiccups is operation on the underlying cause, such as removing a brain or chest tumor, treating a hiatal hernia, or performing anti-reflux surgery (for example, fundoplication). The purpose is to remove or correct the physical trigger irritating the diaphragm or its nerves. The mechanism is direct removal of the source of irritation. Surgery always carries risks like bleeding, infection, and anesthesia complications, so decisions are made carefully by a multidisciplinary team.
Prevention tips
Eat slowly and avoid very large meals to reduce stomach distension.
Limit spicy, very hot, or very cold foods that can irritate the esophagus.
Avoid or reduce carbonated drinks and alcohol, which can trigger or worsen hiccups.
Stay upright for at least 30–60 minutes after eating; do not lie flat immediately.
Maintain a healthy weight and waist size to reduce pressure on the diaphragm.
Manage chronic conditions like reflux, kidney disease, diabetes, or lung disease with the help of health professionals.
Review medicines with your doctor if hiccups start after a new drug, as some medicines can trigger them.
Practice regular stress-reduction techniques like deep breathing or relaxation to lower nervous system over-activation.
Keep good sleep habits, because fatigue and poor sleep can make symptoms feel worse.
Seek early medical evaluation if hiccups keep returning, so underlying causes can be found and treated before they become serious.
When to see a doctor
You should see a doctor or other health professional as soon as possible if:
Hiccups last more than 48 hours, or keep coming back for days or weeks.
Hiccups disturb sleep or make it hard to eat, drink, or speak.
You have weight loss, vomiting, chest pain, difficulty breathing, or trouble swallowing with your hiccups.
You have known serious illness (for example, cancer, kidney failure, stroke, or brain disease) and new or worse hiccups start.
Hiccups appear after a head injury, new neurological symptoms, or major surgery.
Because you are a teenager, it is especially important to talk with a parent/guardian and a doctor rather than trying to manage chronic hiccups alone or with internet remedies.
What to eat and what to avoid
1. Eat: Soft, easy-to-swallow foods (soups, stews, cooked vegetables) that are gentle on the esophagus, especially during bad hiccup episodes.
2. Eat: Small, frequent meals with balanced carbohydrates, proteins, and healthy fats to avoid big swings in stomach fullness.
3. Eat: Fiber-rich foods (fruits, vegetables, whole grains) to prevent constipation and bloating that can raise diaphragm pressure.
4. Eat: Lean protein sources (fish, poultry, legumes) and healthy fats (olive oil, nuts) to support muscle and nerve health overall.
5. Eat: Probiotic foods like yogurt with live cultures or fermented foods, if tolerated, to improve gut balance and reduce gas.
6. Avoid: Very spicy foods, heavy fried meals, and acidic items (like very sour citrus or tomato sauces) that can worsen reflux and irritate the esophagus.
7. Avoid: Carbonated drinks (soda, sparkling water) and chewing gum, which increase swallowed air and stomach gas.
8. Avoid: Large amounts of caffeine and chocolate, which can relax the lower esophageal sphincter and encourage reflux.
9. Avoid: Alcohol and smoking, which irritate the digestive tract and may trigger or worsen chronic hiccups.
10. Avoid: Eating too quickly or talking while eating, because this increases air swallowing and can trigger hiccups.
FAQs
1. Are chronic hiccups dangerous?
Chronic hiccups are not always dangerous by themselves, but they can cause big problems like weight loss, poor sleep, and low mood. More importantly, they can be a sign of serious diseases such as brain disorders, cancers, or organ failure, so they should always be checked by a doctor.
2. What is the difference between normal and chronic hiccups?
Normal hiccups last only a few minutes and stop on their own. Chronic or persistent hiccups last more than 48 hours, and intractable hiccups last more than 1–2 months. If hiccups go on this long, they are not “just normal” and need medical evaluation.
3. What causes chronic hiccups?
Chronic hiccups can come from many causes: stomach and reflux problems, chest or lung disease, ear or throat irritation, brain and spinal cord disease, metabolic problems like kidney failure, infections, and some medicines. Sometimes no clear cause is found, and the condition is called idiopathic.
4. Can stress alone cause chronic hiccups?
Stress and strong emotions can trigger or worsen hiccups by affecting the vagus and phrenic nerves, but long-lasting hiccups usually have more than one cause. Even if stress seems to be a trigger, doctors still need to rule out physical disease.
5. Do home remedies always work?
No. Simple methods like breath-holding, drinking cold water, or swallowing sugar can stop short hiccups for many people, but chronic hiccups often resist these tricks. If hiccups last more than 2 days, home remedies alone are not enough—you need medical advice.
6. Which medicine is officially approved for hiccups?
Chlorpromazine is currently the only medicine with an FDA label specifically mentioning intractable hiccups as an indication. Other drugs like baclofen, gabapentin, and metoclopramide show benefit in studies but are used “off-label,” meaning they are not officially approved just for hiccups.
7. Is it safe to take hiccup medicines without a doctor?
No. Many medicines used for chronic hiccups can cause serious side effects such as movement disorders, sleepiness, heart rhythm problems, liver damage, or breathing depression. They must only be used under medical supervision, with proper dosing and monitoring.
8. Can children or teenagers use these medicines?
Use in children and teenagers is much more limited and must be guided by a pediatric specialist. Some medicines are not approved in young people or have higher risks. Because you are a teen, you should always talk to your parents and your doctor instead of trying any treatment on your own.
9. Can chronic hiccups be cured?
If doctors find and treat an underlying cause—such as reflux, infection, or a tumor—hiccups can sometimes disappear completely. In other cases, the cause is not fully reversible, and the goal is to control the hiccups and protect quality of life using a mix of therapies and medicines.
10. How do doctors find the cause of chronic hiccups?
Doctors start with a careful history and physical exam and may order blood tests, chest X-rays, endoscopy, brain scans, and other studies depending on symptoms. The aim is to look for problems along the hiccup reflex pathway—from the ears, throat, chest, and stomach to the brain and nerves.
11. Can chronic hiccups damage my body?
If they go on for a long time, chronic hiccups can cause dehydration, weight loss, exhaustion, poor sleep, chest pain, and even mood disorders. They can also make it hard to heal from other illnesses. That is why it is important to manage them early.
12. Is surgery commonly used for hiccups?
No. Surgery and invasive nerve blocks are rare and used only for the most severe cases after all simpler options fail. Even then, doctors weigh benefits and risks very carefully, because procedures on nerves that control breathing are serious.
13. Do supplements alone fix chronic hiccups?
Supplements may support general health, nerve function, or digestion, but they do not replace full medical care. They should only be used as part of a plan made with a health professional, especially because some can interact with medicines or be unsafe in kidney or liver disease.
14. Can lifestyle changes really make a difference?
Yes. For some people, simply managing reflux, eating smaller meals, avoiding trigger foods and drinks, and reducing stress greatly lowers hiccup frequency. For others, lifestyle change helps but still needs to be combined with medicines or other therapies.
15. What should I do right now if I or someone I know has chronic hiccups?
If hiccups have lasted more than 48 hours, or come back again and again, the safest next step is to contact a doctor or clinic. While waiting, you can try gentle methods like slow diaphragmatic breathing and sipping water, and avoid large meals and trigger foods. But professional evaluation is essential to rule out serious causes and choose safe treatment.
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.
Chronic Hiccup
