Chemotherapy-induced hiccups are an involuntary and often distressing side effect experienced by some individuals undergoing cancer treatment. These spasms of the diaphragm, the muscle essential for breathing, can significantly impact a patient’s quality of life. While typically self-limiting in the general population, hiccups in cancer patients can be more persistent and bothersome.
Understanding Chemo-Induced Hiccups
Hiccups occur when the diaphragm, the dome-shaped muscle beneath the lungs, contracts suddenly and involuntarily. This spasm causes a rapid intake of air, which is then abruptly halted by the closing of the vocal cords, producing the characteristic “hic” sound. This reflex involves a complex neural pathway, including the phrenic and vagus nerves, which transmit signals between the brain and the diaphragm.
Chemotherapy can trigger hiccups by irritating these nerves or affecting neurotransmitter pathways. Certain chemotherapy drugs, such as cisplatin and oxaliplatin, are associated with chemotherapy-induced hiccups. Additionally, corticosteroids like dexamethasone, often given with chemotherapy to prevent nausea and vomiting, are a frequent cause of hiccups in cancer patients. This irritation can lead to the diaphragm’s spasmodic contractions, resulting in persistent hiccups.
Immediate Home-Based Strategies
When chemotherapy-induced hiccups occur, several immediate, non-pharmacological methods can provide relief. These techniques often work by stimulating the vagus or phrenic nerves or by altering breathing patterns to interrupt the hiccup reflex. Many people find success with simple breathing exercises. Holding your breath for 10 to 20 seconds, or taking a series of short, quick breaths into a paper bag, can help increase carbon dioxide levels in the blood, which may calm the diaphragm.
Drinking methods can also be effective. Slowly sipping cold water, gargling with iced water, or even swallowing crushed ice can stimulate the vagus nerve and help reset the diaphragm’s rhythm. Some individuals find relief by drinking water from the “wrong side” of a glass, which involves bending over and sipping from the far rim. This unusual posture and the act of swallowing can help disrupt the hiccup reflex.
Physical maneuvers offer another set of options. Performing the Valsalva maneuver, which involves exhaling forcefully against a closed mouth and pinched nose, can exert pressure on the vagus and phrenic nerves. Gently pulling on your tongue or bringing your knees to your chest and leaning forward can also help by stimulating nerves in the throat or compressing the diaphragm.
Medical Approaches and Prescribed Treatments
For chemotherapy-induced hiccups that are severe or persist despite home remedies, healthcare providers may prescribe pharmacological interventions. These medications work by targeting different aspects of the hiccup reflex arc. One class of drugs commonly used is muscle relaxants, such as baclofen. Baclofen is thought to reduce the excitability of nerves involved in the hiccup reflex and can interrupt the reflex arc by influencing dopamine release in the central nervous system. Studies have shown baclofen to be effective in resolving or significantly improving persistent hiccups.
Antiemetics, particularly metoclopramide, are another option. This medication, often used to control nausea and vomiting, can suppress hiccups by acting on dopamine receptors. Antiseizure medications like gabapentin also demonstrate effectiveness in managing persistent hiccups. Gabapentin is believed to work by blocking neural calcium channels and increasing gamma-aminobutyric acid (GABA) release, which can modulate the excitability of the diaphragm. These prescription medications should only be used under the guidance of a healthcare professional, who can determine the most appropriate treatment based on the individual’s specific condition and other ongoing therapies.
When Professional Medical Advice is Needed
While most hiccups resolve on their own, it is important to seek professional medical advice, especially during chemotherapy. Contact your oncology team or doctor if hiccups last more than 48 hours. Persistent hiccups can become problematic, leading to fatigue, reduced fluid and food intake, and difficulty sleeping, which can further diminish quality of life for cancer patients.
Other signs warranting medical attention include hiccups that significantly interfere with eating, drinking, or sleeping. If hiccups cause severe pain, or if they are accompanied by other new or worsening symptoms, inform your healthcare team promptly.