Hiccup overview and Definition

Hiccups occurs due to the contraction or spasm of the muscles of the diaphragm and also the spasm occurs in the throat giving rise to the hiccup sound. The larynx and vocal cords closes suddenly. Singultus is the medical term used for the hiccups.


Hiccups are spontaneous , myoclonic contraction of the diaphragm and in many cases the spasm of the intercostal musculature also occurs. The hiccups are generated by a reflex arc with afferent, central and efferent components. The afferent impulses are arrived by the vagus nerve, phrenic nerve and the sympathetic nerve fibers that is from the thoracic outflow that is T6 to T 12. Areas of the CNS involved in the hiccup response appear include the upper spinal cord ( C3 to C5), the brain stem in the medulla oblongata near the respiratory center , the reticular formation and the hypothalamus. Dopaminergic and gamma amino butyric acid ( GABA – ergic) neurotransmitters can modulate this central mechanism. These efferent response of the reflex is carried by the phrenic nerve to the diaphragm that has been observed to contract unilaterally or also bilaterally. Activation of the accessory nerves leads to the contraction of the intercostal muscles.  These mechanism of the reflex is closed by the glottis and it occurs by the recurrent laryngeal nerve. Glottal closure is an important protective reflex because without that the patients with a tracheostomy hiccups lead to significant hyperventilation

Differential Diagnosis

During the physical examination the physician might perform a neurological exam to check the following :

Balance and co-ordination: The physician might check for the balance and co ordination and performs various test to examine that.

Muscle strength and tone: The physician might check for the various reflexes to investigate the muscle tone and muscle strength.

The physician might check for the muscle reflexes, sight and sense of touch.

Laboratory tests:

Samples of the blood might be checked for the signs such as Diabetes, Infection and Kidney disease.

Imaging tests

These types of tests may be able to detect anatomical abnormalities that may be affecting the vagus nerve, phrenic nerve or diaphragm. Imaging tests may include:

It is usually diagnosed with the history of the patient and behavioural changes and impaired cognitive functions.

Magnetic resonance imaging-MRI

Computed tomography-CT

Single photon emission computed tomography

Electroencephalogram(EEG): the doctors might suggest EEG to detect any abnormalities in the brain.

Imaging tests: CT scan, MRI scan SPECTs and  PET scans help doctors locate the tumor and determine if it is cancerous or benign.

Neurological exam: During a neurological exam, your doctor will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that may be affected by a tumor.

Spinal tap:A doctor uses a small needle to remove fluid from around the spine. A laboratory examines this fluid to look for cancer cells. It is also known as lumbar puncture.

Endoscopic tests

These procedures utilize a thin, flexible tube containing a tiny camera, which is passed down your throat to check for problems in your esophagus or windpipe.



Avoid eating bulk or larger quantities of food

Avoid spicy foods

Stay hydrated.