Chronic Hiccup is a sudden, quick tightening (spasm) of the breathing muscle under your lungs, called the diaphragm. Right after this spasm, the small opening between your vocal cords closes and makes the “hic” sound. Most hiccups last only a few minutes and stop on their own. When hiccups go on for a long time, doctors use special names. Persistent or chronic hiccups are usually hiccups that last more than 48 hours and up to about 1–2 months. Intractable hiccups are hiccups that last longer than 1–2 months.
Chronic hiccup (also called persistent or intractable hiccup) means hiccups that do not stop as usual and go on for more than 48 hours, sometimes weeks or months. It happens because the “hiccup reflex arc” (brain, phrenic and vagus nerves, and diaphragm muscle) keeps firing again and again, often due to another medical problem like reflux, stroke, cancer, kidney disease, or medicines. Chronic hiccups can disturb sleep, eating, breathing, mood, and quality of life, so they are not just a joke – they are a real medical issue that needs careful medical assessment and treatment.
Chronic hiccup is important because it can be a sign of another health problem, such as stomach disease, nerve damage, brain disease, or a serious infection. Long-lasting hiccups can also cause big problems by stopping normal sleep, eating, and drinking, and can lead to weight loss, dehydration, and emotional stress.
Other names
Doctors and medical books use several other names for chronic hiccup. Knowing these names can help you understand medical articles.
- Singultus – This is the medical Latin word for hiccups. Many articles use the word “singultus” instead of “hiccups,” especially when they talk about long-lasting or serious cases.
- Persistent hiccups – This means hiccups that last more than 48 hours and do not stop with simple home tricks. These hiccups usually need a medical check-up because they are not normal.
- Chronic hiccups – This is a general name for hiccups that keep going or keep coming back over many days or weeks. Many authors use “chronic” and “persistent” hiccups almost in the same way.
- Intractable hiccups – This means hiccups that last more than 1–2 months and do not get better even after usual treatments. These hiccups are rare but can be very disabling and often mean there is a serious disease in the brain, chest, stomach, or nerves.
- Protracted hiccups or prolonged singultus – Some papers use “protracted,” “prolonged,” or “refractory” to describe hiccups that last a long time and come back again and again even after many therapies.
Types of chronic hiccup
Doctors can group chronic hiccups in different ways. Two simple ways are by how long they last and by where the problem starts in the body.
By duration (how long they last)
Persistent hiccups – Last more than 48 hours but less than about 1–2 months. They should always be checked by a doctor because they often have a treatable cause.
Intractable hiccups – Last longer than 1–2 months. They are often linked with serious diseases or damage in the nervous system, chest, or abdomen, and usually need specialist tests.
By source of the problem in the body
Gastrointestinal type – The problem mainly comes from the food pipe (esophagus), stomach, intestines, liver, pancreas, or gallbladder. Common examples are reflux disease and stomach ulcers.
Nerve irritation type – The problem is irritation or damage to the vagus nerve or phrenic nerve, which carry signals to the diaphragm. This can happen from tumors, swollen organs, infections, or surgery in the neck and chest.
Brain and spinal cord (central nervous system) type – The problem is inside the brainstem, brain, or upper spinal cord, where the hiccup reflex is controlled. Stroke, tumors, multiple sclerosis, and brain bleeding are examples.
Metabolic and systemic type – The problem is from body chemistry, such as kidney failure, severe infection, very low or very high salts in blood, or uncontrolled diabetes.
Drug-induced type – Certain medicines such as steroids, benzodiazepines, opioids, chemotherapy drugs, and some Parkinson’s drugs can trigger or prolong hiccups.
Psychogenic or functional type – Some long-lasting hiccups are linked with stress, anxiety, or other mental health issues when no clear body disease is seen.
Idiopathic type – This means no cause is found even after careful tests. In these cases, doctors mainly treat the symptom and keep watching for new signs.
Causes of chronic hiccup
Many different problems can irritate the hiccup reflex and lead to chronic hiccup. Often more than one factor is present.
Gastroesophageal reflux disease (GERD)
In GERD, acid and stomach contents move back into the food pipe. This acid can irritate the esophagus and nearby vagus nerve fibers. That irritation can trigger persistent hiccups, and treating reflux often helps the hiccups stop.Peptic ulcer or gastritis
Inflammation or ulcers in the stomach or first part of the small intestine can cause pain, bloating, and irritation close to the diaphragm. This irritation can stimulate the hiccup reflex and lead to repeated or chronic hiccups until the ulcer is treated.Large meals and gastric distension
Eating very large meals, swallowing a lot of air, or drinking many fizzy drinks can stretch the stomach and push on the diaphragm. This stretching is a well-known trigger for hiccups and can sometimes make them last for a long time in sensitive people.Hiatal hernia
In a hiatal hernia, part of the stomach slides up through the diaphragm into the chest. This abnormal position can cause reflux and direct irritation near the diaphragm and nerves, both of which may cause repeated bouts of persistent hiccups.Pancreas, liver, or gallbladder disease
Inflammation of the pancreas (pancreatitis), gallstones, or liver swelling can irritate the diaphragm from below. This irritation can send abnormal signals to the phrenic nerve and trigger chronic hiccups, especially when the upper abdomen is inflamed or swollen.Central nervous system lesions (stroke, tumor, multiple sclerosis, etc.)
Damage in the brainstem or upper spinal cord can disturb the hiccup control center. Strokes, tumors, multiple sclerosis plaques, bleeding, and other brain lesions have all been reported as causes of persistent or intractable hiccups.Brain infections and inflammation
Infections such as meningitis or encephalitis can inflame brain tissues around the hiccup reflex arc. Swelling or irritation in these areas may produce chronic hiccups along with headache, fever, or other neurological symptoms.Metabolic problems like kidney failure (uremia)
When the kidneys fail, toxic substances build up in the blood. These metabolic changes can irritate the nervous system and diaphragm and may lead to chronic hiccups in patients with advanced kidney disease.Electrolyte imbalance (salt and mineral problems)
Very low or high levels of sodium, calcium, or potassium can change how nerves and muscles work. These imbalances can make the diaphragm more likely to spasm and can cause long-lasting hiccups until the blood salts are corrected.Diabetes and high blood sugar
Poorly controlled diabetes can damage nerves and cause metabolic problems. Some reports link chronic hiccups with diabetic nerve damage or severe changes in blood sugar, especially when other complications are present.Medicines (steroids, benzodiazepines, opioids, chemotherapy, Parkinson drugs)
Several medicines are known to trigger or prolong hiccups. Examples include dexamethasone and other steroids, benzodiazepines, some chemotherapy drugs, opioid pain medicines, and drugs used for Parkinson’s disease. Stopping or changing these drugs often improves the hiccups.Recent chest or abdominal surgery
Operations in the chest, upper abdomen, or neck can irritate the diaphragm, phrenic nerve, or vagus nerve. After surgery, gas in the abdomen, pain, or wound irritation can all contribute to persistent hiccups during recovery.Heart problems such as heart attack or aortic disease
Heart attack, inflammation around the heart, or enlargement of the aorta in the chest can press on or irritate nearby nerves that control the diaphragm. In some case reports, chronic hiccups were one of the first signs of serious heart or aortic disease.Lung diseases (pneumonia, empyema, tuberculosis, pulmonary embolism)
Infections or fluid around the lungs, such as pneumonia or empyema, can cause inflammation near the diaphragm and phrenic nerve. Tuberculosis and blood clots in the lungs have also been reported to present with persistent hiccups in some patients.Tumors or masses in the chest or abdomen
Cancers in the lungs, mediastinum (middle of the chest), stomach, or liver can push on or invade the nerves that control the diaphragm. When these tumors grow near the phrenic or vagus nerve, chronic hiccups can occur as an early symptom.Ear, nose, or throat problems irritating the vagus nerve
A foreign body or even a hair touching the eardrum, throat inflammation, or goiter in the neck can irritate branches of the vagus nerve. This irritation can sometimes trigger stubborn hiccups until the local problem is treated.Stress, anxiety, and emotional upset
Strong emotions, stress, or anxiety can change breathing patterns and muscle tension. In some patients, psychological stress appears to play a major role in chronic hiccups, especially when no clear physical cause is found.Heavy alcohol use
Alcohol can irritate the stomach, change body chemistry, and affect the brain and nerves. Heavy or long-term alcohol consumption has been linked with both short and long-lasting hiccups, often together with liver or nerve disease.Infections such as tuberculosis or severe systemic infections
Serious infections that spread through the body or affect the lungs, brain, or abdominal organs can change metabolism and irritate nerves. Several case reports describe chronic hiccups as a rare sign of tuberculosis or other serious infections.Idiopathic (no clear cause found)
Sometimes, even after blood tests, imaging, and endoscopy, no cause is found. These cases are called idiopathic. The hiccups may still be severe and need treatment, but doctors focus on symptom control and watching for new signs over time.
Symptoms of chronic hiccup
Chronic hiccup has the main symptom of repeated “hic” sounds, but it also causes many other physical and emotional problems, especially when it lasts for weeks or months.
Continuous or repeated “hic” sounds for more than 48 hours
The most basic symptom is a repeated hiccup sound and chest jerk that do not stop after two days. The attacks can be almost constant or come and go many times each day.Trouble eating and drinking
Because the diaphragm keeps jerking, it can be hard to swallow food or liquids safely. Some people choke easily or feel that food gets stuck, so they start eating less.Weight loss and malnutrition
Ongoing problems with eating and poor appetite can lead to weight loss and lack of important nutrients. In severe cases, patients may become undernourished and weak.Dehydration and dry mouth
If the person drinks less because of discomfort or vomiting, or loses fluid through vomiting and poor intake, dehydration can happen. This may cause dry mouth, dizziness, and tiredness.Severe tiredness and exhaustion
Constant muscle jerks and lack of sleep drain the body’s energy. People with intractable hiccups often feel extremely tired and cannot do normal daily tasks.Difficulty sleeping (insomnia)
Hiccups often continue during the night and wake the person many times. Poor sleep makes pain, anxiety, and fatigue worse, and creates a cycle that is hard to break.Chest or upper belly pain
The repeated jerking of the diaphragm can strain the chest and upper abdominal muscles. Over time, this causes soreness or sharp pain, especially when the person breathes deeply or coughs.Shortness of breath or feeling unable to breathe normally
Because the diaphragm is moving in an abnormal rhythm, some people feel they cannot take a calm, full breath. This can be frightening and may lead to emergency visits, especially if there is lung or heart disease as well.Wound problems after surgery
After chest or abdominal surgery, strong hiccups can cause pressure on stitches or staples. Case reports show that long-lasting hiccups may even contribute to wound opening (dehiscence) or pain at the surgical site.Low mood, depression, and anxiety
Living with hiccups day and night can be very distressing. People often feel embarrassed to speak in public, frustrated, hopeless, or anxious about the cause, which can lead to low mood or depression.Trouble speaking and concentrating
Because the hiccup cuts off the voice suddenly, talking on the phone, teaching, or doing social activities becomes difficult. The constant distraction also makes it hard to focus on work or study.Heartburn, sour taste, or chest burning
When chronic hiccups are due to reflux, people often feel burning pain behind the breastbone, sour taste in the mouth, or food coming back up. These symptoms point toward stomach acid as a main cause.Cough, fever, or breathing symptoms
If the cause is a lung infection, empyema, or tuberculosis, people may have fever, cough with mucus, chest pain, or shortness of breath together with the hiccups. These “red flag” symptoms suggest a serious chest problem.Neurologic symptoms such as headache, weakness, or balance problems
When brain or spinal cord disease is the cause, there may be other signs like severe headache, double vision, weakness in an arm or leg, slurred speech, or trouble walking. Chronic hiccups plus these signs need urgent brain imaging.Palpitations or chest pressure with heart disease
If heart attack or aortic disease is present, the person may feel chest pressure, pain, or a racing heartbeat, sometimes together with hiccups. In these cases, chronic hiccups are a warning sign of a life-threatening condition.
Diagnostic tests for chronic hiccup
Doctors choose tests for chronic hiccup based on the person’s age, medical history, and other symptoms. The goal is to find and treat any serious underlying disease.
Clinical history and symptom interview
The first “test” is a careful talk with the patient about when the hiccups started, how long they last, what makes them better or worse, and what other symptoms are present. This helps the doctor decide which organs or systems are most likely involved and which tests are needed next.General physical examination with vital signs
The doctor checks blood pressure, pulse, temperature, breathing rate, weight, and general appearance. They also look for signs of dehydration, weight loss, jaundice, or infection. These clues may point toward kidney failure, infection, cancer, or other systemic diseases.Neurological examination
A detailed brain and nerve exam checks eye movements, face strength, speech, arm and leg power, reflexes, and balance. Finding weakness, abnormal reflexes, or eye changes can suggest stroke, tumor, or multiple sclerosis as the cause of chronic hiccups.Chest and abdominal examination
The doctor listens to the lungs and heart, taps over the chest, and carefully feels the abdomen for tenderness, enlarged liver, or masses. Pain or abnormal sounds may suggest lung infection, fluid around the lungs, liver disease, or stomach problems linked to the hiccups.Ear, nose, and throat examination
The doctor looks into the ears, nose, and throat to check for infection, foreign bodies, or other sources of vagus nerve irritation. In rare cases, a small object or even a hair touching the ear drum has been enough to cause persistent hiccups until it was removed.Breath-holding and slow breathing maneuvers
Simple bedside tests, such as asking the patient to hold their breath or slowly breathe into a paper bag, can temporarily change the diaphragm rhythm. The doctor may observe whether these maneuvers stop or reduce the hiccups, which helps understand how reactive the reflex is.Vagal maneuvers
Vagal maneuvers, like gently bearing down as if to pass stool, drinking cold water, or performing a cough, stimulate the vagus nerve. These bedside tests can sometimes break the hiccup cycle and also show whether nerve-based approaches are helpful for this patient.Positional change test
The doctor may ask the person to sit up, lie on one side, or bend forward after eating to see if body position changes the hiccups. If symptoms clearly worsen when lying flat or after meals, this points toward reflux or stomach-related causes.Complete blood count (CBC)
A CBC measures red cells, white cells, and platelets. Abnormal results may suggest infection, anemia, blood cancer, or other bone marrow problems that could be related to chronic hiccups or their underlying cause.Serum electrolytes (sodium, potassium, calcium, etc.)
Blood tests for electrolytes look for low or high levels of key minerals. As these levels strongly affect nerve and muscle function, correcting electrolyte problems can sometimes stop chronic hiccups.Kidney function tests (BUN and creatinine)
These tests show how well the kidneys are working. In kidney failure, toxins can build up and irritate the nervous system, so abnormal results can explain chronic hiccups in some patients.Liver function tests
Liver enzymes and bilirubin levels help detect liver inflammation, blockage, or cirrhosis. Liver disease can cause swelling, fluid in the abdomen, and metabolic problems that may contribute to persistent hiccups.Blood sugar and HbA1c tests
Checking fasting blood sugar and long-term sugar control (HbA1c) can reveal previously unknown diabetes or poor control. Since diabetes can damage nerves and cause metabolic changes, these tests are important in long-term hiccup evaluation.Electrocardiogram (ECG)
An ECG records the electrical activity of the heart. It can help detect heart attack, rhythm problems, or pericarditis, which may rarely present with chronic hiccups as a symptom. ECG is recommended when heart disease is suspected or when there is chest pain.Chest X-ray
A simple chest X-ray can show lung infections, collapsed lung, enlarged heart, fluid around the lungs, or large tumors. Many case reports describe chest X-ray as a key test that uncovered the cause of persistent hiccups, such as aortic disease or empyema.Upper gastrointestinal endoscopy
Endoscopy uses a flexible camera to look at the esophagus and stomach. It helps find reflux damage, ulcers, tumors, or hiatal hernia. Because reflux and stomach disease are common causes of chronic hiccups, endoscopy is often part of the workup when symptoms do not improve.24-hour esophageal pH monitoring
In this test, a small probe measures acid levels in the lower esophagus for 24 hours. It is very helpful in proving GERD as the cause of chronic hiccups, especially when endoscopy looks normal but symptoms suggest reflux.Brain MRI
Magnetic resonance imaging (MRI) of the brain is used when doctors suspect stroke, tumor, multiple sclerosis, or other central nervous system lesions. Brain MRI can show small changes in the brainstem or other areas involved in the hiccup reflex that might not be seen on simpler scans.Chest and upper abdomen CT scan
Computed tomography (CT) gives detailed pictures of the lungs, mediastinum, diaphragm, and upper abdominal organs. CT can detect tumors, enlarged lymph nodes, aortic disease, empyema, and other structural problems that have been linked to persistent hiccups.Abdominal ultrasound
Ultrasound uses sound waves to look at the liver, gallbladder, pancreas, and other abdominal organs. It can detect gallstones, liver enlargement, or masses that may irritate the diaphragm and help explain the chronic hiccup problem.
Non-pharmacological treatments for chronic hiccup
Slow deep breathing and breath-holding practice
Slow deep breathing, followed by gently holding the breath for a few seconds, can temporarily change the amount of carbon dioxide in the blood and reset the hiccup reflex. Many people repeat “inhale, hold, exhale” a few times until hiccups ease. This method is simple, free, and safe for most people when done sitting upright. It is often used as a first step before medicines, especially in mild or early chronic hiccups.Breathing into a paper bag (short, supervised use)
Briefly breathing in and out of a paper bag (never plastic, and never if you feel dizzy or have heart/lung disease) can gently raise carbon dioxide levels. Higher carbon dioxide may quiet the nerve signals that trigger the diaphragm spasms. Doctors sometimes suggest this for short periods only and with care, because over-doing it can cause light-headedness or low oxygen.Sipping cold water slowly
Taking many small sips of cold water can stimulate the throat and vagus nerve and may break the hiccup cycle. The cold temperature plus swallowing rhythm sends new signals to the brainstem and can “distract” the reflex. It is safe for most people, but anyone at risk of choking needs to sip carefully, ideally sitting upright.Gargling with cold water
Gargling ice-cold water stimulates the soft palate and back of the throat, which affects vagus nerve activity. This sudden sensory input can sometimes interrupt the hiccup reflex arc. It is an easy home option, but not suitable for people who cannot safely control a gargle (for example, some neurological conditions).Valsalva maneuver (gentle “bearing down”)
The Valsalva maneuver means gently blowing out against a closed airway, such as blowing into a syringe or holding the nose and trying to exhale. This temporarily changes chest pressure and stimulates the vagus nerve and heart reflexes. For hiccups, a mild version under medical advice can reset the reflex loop, but it should be avoided in people with certain heart or eye problems.Swallowing a teaspoon of granulated sugar
Swallowing a spoon of dry sugar is a traditional method that gives a sudden strong sensation in the mouth and esophagus. This can change sensory signals traveling to the brain and may stop the hiccup sequence. Evidence is mainly anecdotal, but because sugar is generally safe (unless someone has diabetes or other restrictions), it is sometimes tried before medicines.Sour or strong-tasting foods (like lemon)
Biting a lemon slice, tasting vinegar, or other sharp flavors can give a strong stimulus to taste nerves and the vagus nerve. This intense flavor shock may “over-ride” the hiccup reflex. Clinical evidence is limited, but case reports and practice guidelines list sour foods as a possible non-drug option for persistent singultus.Posture changes and gentle chest compression
Pulling the knees up toward the chest, leaning forward, or hugging a pillow against the chest can change pressure around the diaphragm. These positions may reduce mechanical irritation and calm diaphragm spasms. Health professionals may teach safe positions that support breathing while trying to interrupt chronic hiccups.Nasopharyngeal stimulation (under medical supervision)
Putting a small tube or catheter in the nose to gently touch the back of the throat can strongly stimulate nerves, including the vagus nerve. This has been used in hospitals to stop stubborn hiccups, but it must be performed by trained staff because it can cause discomfort, bleeding, or gagging. It is not a home method.HiccAway® or similar suction “straw” devices
New devices shaped like a firm straw with a small hole require extra suction effort to pull water through. This effort activates the diaphragm and epiglottis in a controlled way and has shown positive results in a prospective study for hiccups. It is a non-drug option some people may try after talking with a clinician.Acupuncture
Acupuncture uses fine needles at specific body points to influence nerves and brain centers. Several trials and reviews, mainly from China, suggest acupuncture and related methods (electro-acupuncture, acupressure) can improve persistent or intractable hiccups, especially after stroke or brain injury, although study quality is mixed. It should be done by a qualified practitioner and usually together with standard medical care.Acupressure (finger pressure on acupuncture points)
Acupressure uses firm finger pressure instead of needles on points such as around the eyebrows or on the wrist. Small studies report good success in chronic hiccup, and it can often be taught to patients or caregivers as a safe self-care tool. The idea is that pressure on these points helps rebalance the hiccup reflex and calm abnormal nerve firing.Hypnosis and relaxation therapy
Hypnosis and guided relaxation can reduce anxiety, muscle tension, and focus on the hiccup feeling. Case reports describe patients with long-lasting hiccups who improved with hypnotic techniques after drug treatments failed. These methods may work by changing brain attention and autonomic nervous system activity that drives the reflex.Psychological support and stress management
Chronic hiccups can cause embarrassment, sadness, and sleep loss, which may then worsen the hiccups through stress. Counseling, cognitive-behavioral therapy, or simple coping skills (sleep routines, relaxation breathing, supportive talk) help patients handle the distress and may reduce symptom intensity. Good mental health support is especially important in long-lasting cases.Treating gastroesophageal reflux (non-drug methods)
Reflux of stomach acid into the esophagus often triggers or worsens chronic hiccups. Simple measures like raising the head of the bed, not lying down soon after meals, eating smaller meals, and avoiding very spicy or fatty foods can reduce reflux. When reflux improves, the irritation to the diaphragm and vagus nerve may also lessen, which can calm hiccups.Physiotherapy for diaphragm and breathing muscles
A physiotherapist can teach breathing exercises and gentle chest and neck stretches to improve diaphragm control and reduce stiffness in surrounding muscles. In some cases of neurological disease or after surgery, targeted rehabilitation of breathing patterns can help reduce chronic hiccup attacks and improve stamina.Transcutaneous nerve stimulation devices (experimental)
Some reports describe using skin-surface electrical nerve stimulation near cervical nerves or the diaphragm area to influence the hiccup reflex arc. These devices deliver small electric pulses and are still under study. They may be considered only in specialized centers when more established treatments do not work.Sleep hygiene and regular day–night routine
Chronic hiccups often disturb sleep, and poor sleep can increase pain sensitivity and nervous system instability. Keeping a regular sleep schedule, avoiding caffeine near bedtime, and creating a calm bedroom environment can support brain recovery and may indirectly lessen hiccup frequency and the distress they cause.Nutritional support and maintaining hydration
Long-term hiccups can make eating and drinking hard, causing weight loss and dehydration. A dietitian can suggest soft, energy-dense foods, smoothies, and scheduled sips of fluid. Maintaining good nutrition protects muscles, nerves, and immunity, which helps the body handle both the cause of the hiccup and any treatments.Time and monitoring in mild cases
For some people, “chronic” hiccups may still improve spontaneously if the trigger (like a recent surgery or infection) settles. In such cases, doctors may choose close watching plus simple non-drug measures first, while checking for serious causes. This avoids unnecessary medicines and lets the body recover naturally, with a plan to escalate treatment if hiccups continue.
Drug treatments for chronic hiccup
Very important: Only a doctor can decide which medicine is right, the exact dose, and how long to use it. Most of these are off-label for hiccups, except chlorpromazine, which is the only drug specifically approved for intractable hiccups.
Chlorpromazine
Chlorpromazine is an antipsychotic medicine and is the only drug officially approved for intractable hiccups. FDA labeling lists “intractable hiccup” as an indication, and typical adult dosing for singultus starts with oral doses several times daily, with options for intramuscular or slow IV infusion if needed under close monitoring. It blocks dopamine and other receptors in the brain, calming the hiccup reflex arc, but can cause low blood pressure, sleepiness, dry mouth, urinary retention, and movement problems, so doctors use it cautiously and usually for short periods.Baclofen
Baclofen is a muscle relaxant and GABA-B receptor agonist commonly used for spasticity. Studies and case reports show that baclofen can reduce chronic or intractable hiccups by damping down excitability in the spinal cord and brainstem hiccup pathway. Typical adult doses start low (for example 5–10 mg three times daily) and are adjusted by a doctor; main side effects are drowsiness, dizziness, and weakness.Gabapentin
Gabapentin is an anticonvulsant and nerve-pain medicine that modulates calcium channels and reduces abnormal nerve firing. Case series and trials in palliative-care patients suggest gabapentin can be effective and relatively well tolerated for persistent hiccups, especially when there is central nervous system disease or cancer. Doctors usually start with low doses and increase gradually to limit dizziness and sleepiness.Metoclopramide
Metoclopramide is a dopamine-antagonist and pro-kinetic drug used mainly for nausea and slow stomach emptying. Randomized and pilot studies show metoclopramide can help relieve intractable hiccups, particularly when related to stroke, cancer, or gastrointestinal disease, probably by acting on dopamine receptors and improving gastric motility. It is usually given before meals and at bedtime; side effects can include restlessness, diarrhea, and, with longer use, movement disorders, so duration is carefully limited.Haloperidol
Haloperidol is another antipsychotic that strongly blocks dopamine receptors. It has been used as an alternative to chlorpromazine for persistent hiccups, including in palliative-care settings. Low doses may quiet the reflex arc with fewer blood-pressure changes than chlorpromazine, but risks include stiffness, tremor, and rare serious movement or heart rhythm effects, so monitoring is essential.Olanzapine
Olanzapine is an atypical antipsychotic sometimes used off-label when standard drugs fail. Case reports describe control of severe hiccups with low nightly doses, possibly because it blocks dopamine and serotonin receptors that influence the hiccup reflex. It can cause weight gain, sleepiness, and metabolic changes, so doctors weigh risks and benefits carefully.Nifedipine
Nifedipine is a calcium-channel blocker normally used for high blood pressure and angina. Small reports suggest oral nifedipine may help some patients with intractable hiccups, perhaps by relaxing smooth muscles and altering nerve excitability. Blood pressure can drop with nifedipine, so clinicians watch for dizziness, flushing, and ankle swelling.Amitriptyline
Amitriptyline is a tricyclic antidepressant often used for pain and migraines. It affects serotonin and norepinephrine pathways and has been tried for chronic hiccups in certain neurological conditions. It may help by stabilizing central nervous system activity and improving sleep, but can cause dry mouth, constipation, and drowsiness.Valproic acid (valproate)
Valproic acid is an antiepileptic drug that increases GABA levels and stabilizes neuronal firing. Case reports list valproate among medicines that sometimes reduce troublesome hiccups, especially when seizures or mood problems co-exist. Doctors must monitor liver function, clotting, and drug interactions; it is absolutely not used in pregnancy because of birth-defect risk.Carbamazepine
Carbamazepine is another anticonvulsant drug that stabilizes sodium channels. It has been used off-label in some patients whose hiccups are linked to central nervous system lesions. Like other anticonvulsants, it needs careful dose titration and blood tests because it can affect blood counts, sodium, and liver function.Phenytoin
Phenytoin is an older antiepileptic medicine. Reports list it as one of the drugs sometimes tried for refractory hiccups, likely through its effect on neuronal excitability. Due to its narrow therapeutic range and many interactions, phenytoin is now used less often and only with close monitoring.Lidocaine (intravenous)
Lidocaine is a local anesthetic that can also be given IV in special settings. In some acute severe hiccup cases, a carefully controlled IV lidocaine infusion has reduced symptoms, possibly by depressing abnormal nerve activity in the diaphragm region. Because it can cause heart rhythm changes and numbness, it is reserved for monitored hospital use.Midazolam
Midazolam is a short-acting benzodiazepine sedative. It has been used for severe, distressing hiccups, especially around surgery or in intensive-care settings, mainly to reduce anxiety, muscle tension, and awareness of symptoms. It can slow breathing and cause strong drowsiness, so it is given only by clinicians with monitoring.Proton-pump inhibitors (PPIs, e.g., omeprazole)
PPIs reduce stomach acid and are not direct hiccup drugs, but they are important when reflux is a trigger. By healing esophagitis and reducing acid exposure to the diaphragm and vagus nerve, PPIs can indirectly improve chronic hiccups in many patients. Side effects are usually mild but long-term high-dose use should still be monitored.H2 blockers (e.g., ranitidine, famotidine)
H2 blockers also reduce stomach acid, though less strongly than PPIs. They are sometimes used when PPIs are not tolerated or as part of a stepwise reflux management plan. By lowering acid irritation, they may help reduce hiccup triggers in some people.Domperidone or other pro-kinetics (where available)
Domperidone is a dopamine-blocking pro-kinetic used in some countries (with cardiac safety checks). Like metoclopramide, it speeds stomach emptying, which may reduce reflux-related hiccups. Its safety regulations differ by country, so doctors follow local guidance before using it.Tandospirone (5-HT1A agonist, experimental)
Tandospirone is an anti-anxiety drug acting on serotonin 5-HT1A receptors. Some reports suggest it can help hiccups by inhibiting phrenic nerve activity and calming the brainstem. However, evidence is limited, and it is not widely available in all countries, so use is specialist-guided and off-label.Steroids (e.g., dexamethasone, in selected causes)
Corticosteroids are not standard hiccup drugs, but if chronic hiccups come from brain tumors, meningitis, or inflammation, steroids may reduce swelling around key nerves. As the underlying inflammation settles, hiccups may also improve. Because steroids have many side effects (weight gain, high blood sugar, infection risk), they are used only when clearly needed.Anti-nausea combination regimens
In patients with cancer, chemotherapy, or severe reflux, doctors often combine anti-nausea drugs (for example, a PPI plus metoclopramide or a serotonin-antagonist) to reduce triggers like gastric irritation and distension. The goal is to manage the underlying driver of hiccups rather than the hiccup sound itself. Regimens are personalized to avoid strong side effects or drug clashes.Other rescue medicines (case-by-case)
A few other drugs such as amantadine or benzodiazepines have been reported for stubborn hiccups, but evidence is weak. Specialists may consider them only after careful review of the patient’s full medical situation and after standard options have failed, always balancing potential benefit against sedation, confusion, or other harms.
Dietary molecular supplements
Evidence that supplements directly cure chronic hiccup is very limited. They may support nerves, muscles, or underlying diseases. Always discuss supplements with a clinician.
Magnesium – Magnesium helps nerves and muscles relax and is often used for muscle cramps. In theory, correcting low magnesium might help diaphragm stability and reduce spasm-like activity. A doctor may suggest a moderate daily dose based on blood levels. Too much magnesium can cause diarrhea or, in kidney disease, dangerous high levels.
Vitamin B complex (B1, B6, B12) – B vitamins are important for healthy nerves and energy metabolism. If chronic hiccups are linked to neuropathy, malnutrition, or alcohol excess, correcting B-vitamin deficiency can support nerve repair. Doctors may use tablets or injections depending on tests. Excessive doses, especially B6, can itself damage nerves, so supervised dosing is important.
Vitamin D – Vitamin D supports muscle function, bones, and immune balance. Low vitamin D is common in many chronic illnesses. Replacing it to normal ranges may improve overall muscle strength and wellbeing, which indirectly helps people cope with chronic hiccups and underlying disease. Blood testing guides safe dosing to avoid overdose.
Omega-3 fatty acids (fish oil or algae oil) – Omega-3s have anti-inflammatory effects and support brain and nerve health. In chronic conditions with inflammation, adding omega-3 (for example, EPA/DHA capsules with meals) may gently lower inflammatory signals that irritate nerves. Side effects can include mild stomach upset and, rarely, increased bleeding tendency at high doses.
Probiotics – Probiotic bacteria can help balance gut flora and may improve gas, bloating, or reflux in some people. Because gastric distension and reflux can trigger hiccups, improving gut comfort may reduce attacks. A doctor or dietitian can help choose safe preparations, especially in people with weak immune systems.
Melatonin – Melatonin is a hormone involved in sleep–wake rhythm and has some antioxidant and nerve-modulating actions. In patients whose chronic hiccups are worse at night, carefully timed melatonin may improve sleep quality and indirectly reduce distress. It can cause morning sleepiness in some people, so the dose and timing should be individualized.
Ginger extract – Ginger has pro-kinetic and anti-nausea properties and can soothe indigestion. Capsules or teas might help reduce stomach bloating and mild reflux, thereby lowering one mechanical trigger for hiccups. However, strong preparations can irritate the stomach in some people or interact with blood thinners, so medical advice is wise.
Curcumin (turmeric extract) – Curcumin has anti-inflammatory and antioxidant effects and is sometimes used in chronic inflammatory disorders. By reducing low-grade inflammation, it may support nerve and muscle health around the diaphragm region. Absorption is improved with formulations that include piperine; high doses may upset the stomach or interact with medicines.
Coenzyme Q10 – CoQ10 is involved in mitochondrial energy production and may support muscle and nerve function. In theory, better energy supply to respiratory muscles could improve endurance and recovery when chronic hiccups exhaust the patient. Evidence for hiccup is indirect, so any use should focus on clear deficiency or co-existing heart conditions under specialist care.
L-carnitine – Carnitine helps transport fatty acids into cells for energy production. It is sometimes used for muscle fatigue in certain metabolic or cancer-related situations. Supporting overall muscle metabolism might help patients deal better with the strain of long-term hiccups, but again, this is indirect, and doses must be individualized to avoid nausea or cramps.
Regenerative and immune-modulating drugs
There are no stem-cell or “regenerative” drugs approved specifically for chronic hiccups. The medicines below act on immunity or repair in serious underlying diseases that can cause hiccups; they are used only by specialists.
Intravenous immunoglobulin (IVIG)
IVIG contains pooled antibodies from donors and is used for autoimmune and inflammatory nerve diseases. If chronic hiccups are due to an autoimmune attack on nerves controlling the diaphragm or brainstem, IVIG may help by calming that abnormal immune response. Treatment is given in hospital over hours or days, with careful monitoring for headache, allergy, or clotting problems.High-dose corticosteroids (e.g., methylprednisolone pulses)
In conditions like autoimmune encephalitis, myelitis, or inflammatory brain lesions that trigger hiccups, short courses of high-dose IV steroids can reduce swelling and immune activity. As inflammation settles, hiccup frequency may fall. These strong drugs can cause high blood sugar, mood changes, infection risk, and bone loss, so they are used only when benefits clearly outweigh risks.Biologic immunomodulators (e.g., rituximab in selected autoimmune disease)
Biologic drugs such as rituximab target specific immune cells (like B cells). In rare cases where chronic hiccups are part of a severe autoimmune disease, treating that disease with biologics may indirectly stop hiccups. These treatments are given as infusions in hospital and come with serious infection risks, so they are reserved for carefully selected patients.Neuroprotective agents under study
Some experimental drugs aim to protect neurons from damage in conditions like stroke or neurodegeneration. If future research proves that protecting brainstem areas reduces chronic hiccups, these agents might be added to treatment plans. At present, they are part of research trials and not routine therapy for hiccups.Stem-cell–based therapies (only in clinical trials)
Stem-cell therapies try to repair or replace damaged nervous tissue. They are highly experimental and sometimes studied in spinal cord injury or severe neurological disease. There is no standard stem-cell treatment for chronic hiccup itself. If ever offered, it should only be within regulated clinical trials at recognized centers.Regenerative rehabilitation programs
Although not a single “drug,” some centers combine medications, physical therapy, and neuromodulation techniques to support recovery of respiratory and swallowing function after injury. These programs may, in specific cases, reduce hiccup severity by improving overall nerve–muscle coordination. Participation is guided by rehabilitation physicians and neurologists.
Surgical procedures for chronic hiccup
Surgery is only considered after full medical work-up and after medicines and less invasive methods fail, because these procedures can have serious risks.
Phrenic nerve block
A phrenic nerve block involves injecting local anesthetic (sometimes with steroids) around the nerve that controls the diaphragm, usually guided by ultrasound or CT. This can temporarily stop diaphragmatic spasms and give relief from intractable hiccups. Case series show that phrenic nerve blocks may help when other therapies fail, but they can cause temporary breathing weakness on that side and must be done by experienced anesthesiologists.Phrenic nerve clipping or crushing (surgical interruption)
In very severe cases, surgeons may partially interrupt the phrenic nerve using a clip or careful crushing technique to reduce its activity. Reports describe improvement in chronic hiccups when other treatments failed, but there is a risk of permanent diaphragm paralysis on that side and breathing problems. Newer methods sometimes use temporary clips that can be removed later.Diaphragmatic pacing / stimulation
Diaphragmatic pacing involves electrically stimulating the diaphragm via implanted leads or transesophageal electrodes. It is more often used for respiratory failure, but case reports show it has been tried to control persistent hiccups by taking over controlled rhythmic contractions. Because it is complex and invasive, it is rare and reserved for very selected patients.Vagus nerve stimulation (VNS)
Vagus nerve stimulation uses an implanted device (similar to some epilepsy treatments) that sends regular mild electrical signals along the vagus nerve. Case reports show mixed results: some patients have strong improvement, others do not, and occasionally VNS itself has been linked to new hiccups. It is an advanced, expensive option chosen only after detailed neurological and surgical evaluation.Surgery for the underlying cause
Sometimes the “surgery for hiccup” is actually surgery for the disease causing it, such as fixing a large hiatal hernia, removing a tumor pressing on the diaphragm or vagus nerve, or dealing with a brain lesion. When the physical cause is corrected, the abnormal stimulation of the reflex arc can stop and the chronic hiccup may resolve. Surgeons and physicians decide together whether such operations are safe and worthwhile.
Prevention of chronic hiccup
Treat reflux and indigestion early – Manage heartburn and reflux with lifestyle changes and doctor-advised medicines so the diaphragm and vagus nerve are not constantly irritated.
Avoid large, heavy meals and late-night eating – Smaller, more frequent meals reduce stomach over-stretching and reflux, both of which can trigger hiccups.
Limit carbonated and very fizzy drinks – Gas in fizzy drinks can expand the stomach and push on the diaphragm, so cutting these down may reduce episodes.
Reduce alcohol and smoking – Alcohol and smoking can irritate the esophagus and stomach and may affect nerve function, making hiccups more likely and harder to control.
Manage chronic diseases well – Good control of diabetes, kidney disease, lung disease, or neurological conditions lowers the chance that they will provoke chronic hiccups.
Review medicines with your doctor – Some medicines (for example, steroids, anesthetics, certain chemotherapy drugs) have been linked to hiccups. Regular medication reviews can spot and adjust any possible triggers.
Protect mental health and sleep – Stress and sleep loss can make chronic symptoms feel worse. Simple habits like consistent sleep times, relaxing activities, and support from friends or counselors help resilience.
Stay hydrated and nourished – Drinking enough fluids and eating balanced meals support muscle and nerve function and prevent the weakness and fatigue that make chronic hiccups harder to cope with.
Follow up after surgery or serious illness – If hiccups start after an operation, stroke, or infection, early medical review can identify treatable causes before they become persistent.
Keep regular medical check-ups – Routine health checks and lab tests help discover hidden problems (like electrolyte imbalance, kidney issues, or tumors) that might later present as chronic hiccups.
When to see a doctor
You should see a doctor if hiccups last longer than 48 hours, if they keep coming back for days or weeks, or if they interfere with eating, drinking, sleeping, or breathing. Long-lasting hiccups can signal serious illnesses such as strokes, brain or chest tumors, kidney failure, or severe infections, and only a doctor can rule these out with proper tests. You also need urgent medical help if hiccups come with chest pain, severe headache, confusion, weakness, vomiting blood, or major weight loss. For a teen, telling a parent or trusted adult and seeing a doctor promptly is very important.
What to eat and what to avoid
Eat small, frequent meals – Smaller meals put less sudden stretch on the stomach and reduce pressure on the diaphragm, which can help prevent hiccup triggers.
Choose soft, easy-to-swallow foods – Soft foods, soups, and smoothies are often easier to handle if hiccups make chewing or swallowing difficult, helping you keep up calories and nutrients.
Include lean protein and healthy fats – Foods like fish, eggs, beans, nuts, and seeds support muscle repair and nerve function, which is useful when long-term hiccups cause fatigue.
Add fruits and vegetables that are gentle on reflux – Non-acidic fruits (like bananas) and cooked vegetables are usually kinder to the stomach and provide vitamins and antioxidants.
Drink water regularly in small sips – Frequent small sips keep you hydrated without over-filling the stomach, and the swallowing rhythm itself can sometimes soothe mild hiccups.
Avoid very spicy and very fatty foods – Strongly spicy, greasy, or fried foods can worsen reflux and gastric irritation, which may trigger or prolong hiccups.
Limit caffeine (coffee, energy drinks) – Caffeine can increase stomach acid and sometimes anxiety or heart rate, which may make symptoms feel worse in some people.
Avoid large amounts of chocolate and mint – These foods can relax the lower esophageal sphincter, encouraging reflux and possibly worsening hiccups in reflux-sensitive people.
Reduce carbonated drinks – Fizzy drinks add gas to the stomach, causing bloating and more pressure on the diaphragm, which can contribute to hiccup episodes.
Avoid alcohol if possible – Alcohol irritates the stomach lining and can disturb brain and nerve function, increasing both the risk and severity of chronic hiccups.
Frequently asked questions (FAQs)
Is chronic hiccup dangerous or just annoying?
Chronic hiccup can be both. It starts as an annoying symptom, but over time it can cause weight loss, dehydration, exhaustion, and depression. Sometimes it is the first visible sign of a serious disease such as stroke, cancer, or organ failure, which is why doctors take long-lasting hiccups seriously and investigate the cause.How long does a hiccup episode have to last to be called “chronic”?
Acute hiccups usually last less than 48 hours. When hiccups continue beyond 48 hours, they are called persistent; beyond a month, they are often labeled intractable or chronic. These terms help doctors decide how aggressively to search for underlying causes and what treatments to use.Can stress alone cause chronic hiccups?
Stress and anxiety do not usually cause chronic hiccups by themselves, but they can make attacks more frequent or harder to tolerate. Often, there is also a physical trigger such as reflux, medication, or a neurological problem. Managing stress with relaxation techniques can still be a useful part of treatment.Why is chlorpromazine special for chronic hiccup?
Chlorpromazine is special because it is the only medicine specifically approved by major regulators for intractable hiccups. Its official drug label lists “intractable hiccup” as an indication. However, it can have strong side effects, so many experts now prefer trying baclofen or gabapentin first and keeping chlorpromazine as a backup or short-term option.Are baclofen and gabapentin safe for long-term use in hiccups?
Studies and experience suggest baclofen and gabapentin can be helpful for persistent hiccups, with side effects mainly being sleepiness, dizziness, and fatigue. Still, long-term use needs regular doctor review, and doses may be reduced once hiccups improve. In teens, specialists will be extra careful and adjust doses for age and weight.Can chronic hiccups come back after they stop?
Yes. Even after successful treatment, hiccups can return if the underlying trigger comes back (for example, reflux flares again, or a tumor progresses). That is why follow-up visits, long-term control of chronic diseases, and healthy habits are important to keep symptoms down.Do home remedies like sugar or lemon really work?
Some people get quick relief from methods like swallowing sugar, biting lemon, or drinking cold water, and these methods are widely mentioned in medical reviews as low-risk non-drug options. However, they do not work for everyone, and they do not fix serious underlying causes, so medical evaluation is still needed for long-lasting hiccups.Can I try medicines for hiccups on my own?
No. Many hiccup medicines can cause serious side effects such as very low blood pressure, abnormal heart rhythms, or movement problems, especially if taken in the wrong dose. You should never start prescription medicines, or change their doses, without a doctor’s advice. As a teenager, you should always involve a parent or guardian in these decisions.Are there any tests to find the cause of chronic hiccups?
Doctors may order blood tests to look for infections, kidney problems, or electrolyte disturbances; imaging such as chest X-ray, CT, or MRI to check the brain, chest, or abdomen; and endoscopy to view the esophagus and stomach. They choose tests based on your story and physical exam findings.Can chronic hiccups affect mental health?
Yes. Constant hiccups can disturb sleep, eating, social life, and work or school, and can lead to frustration, sadness, or depression. It is important to tell your healthcare team about these feelings so they can offer psychological support and, if needed, counseling or medications to help mood and sleep.Is surgery a permanent cure?
Surgery such as phrenic nerve block, clipping, or vagus nerve stimulation can help some people, but results vary. Some patients get long-term relief, others only temporary benefit, and some do not respond. Because surgery carries risks like breathing problems or device complications, it is kept as a last option when exhaustive medical treatment has failed.Can children or teens get chronic hiccups?
Yes, though chronic hiccups are more often reported in adults, especially older adults. In kids and teens, doctors are particularly careful to look for treatable causes like reflux, infections, or medication effects and to choose treatments with safe side-effect profiles for younger people.Is there a simple cure that works for everyone?
Sadly, no single cure works for all cases. The best results come from finding and treating the underlying cause when possible, using a mix of non-drug measures, carefully chosen medicines, and in rare cases procedures or surgery. Treatment plans are personalized based on age, other illnesses, and what has already been tried.Can lifestyle changes alone fix chronic hiccups?
Sometimes, especially if the cause is mild reflux, overeating, or certain everyday habits. But if hiccups are driven by serious disease, lifestyle changes alone are not enough. They are still important, though, because they support overall health and make medical treatments work better.What should I do right now if I or someone I know has chronic hiccups?
If hiccups have lasted more than 48 hours or are causing trouble with eating, drinking, sleeping, or breathing, the safest step is to see a doctor soon – for you, that means telling a parent or trusted adult and arranging a clinic visit. While waiting, you can try simple, safe methods like slow deep breathing, sipping cold water, and small meals, but do not start any prescription medicines without medical advice.
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.
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