Hiccups, medically known as singultus, are a common, involuntary phenomenon involving sudden spasms of the diaphragm. This muscular sheet, located beneath the lungs, is crucial for breathing. Typically, these spasms are brief, lasting only a few seconds or minutes, and often resolve without any intervention. However, some individuals experience hiccups that persist for unusually long periods, prompting curiosity about the limits of this common reflex.
The Record-Breaking Case
The longest documented case of hiccups belongs to Charles Osborne, an American man who hiccupped continuously for an astonishing 68 years. His extraordinary ordeal began on June 13, 1922, when he fell while weighing a hog, and continued until February 1990. Doctors theorized the fall might have caused a minute injury, possibly a ruptured blood vessel in his brain stem, disrupting the nerve pathway inhibiting the hiccup response.
During the early decades of his condition, Osborne experienced hiccups at a rate of about 40 times per minute, which later slowed to around 20 per minute. This constant jerking significantly impacted his daily life, making eating, sleeping, and speaking challenging. He learned to minimize the characteristic “hic” sound by breathing methodically between spasms.
Despite his condition, Osborne led a relatively normal life, marrying twice and fathering eight children, and even worked as an auctioneer. He resorted to blending his meals to consume them and tried numerous remedies, none of which provided a lasting cure. Mysteriously, his hiccups ceased just a year before his death in May 1991.
Understanding Persistent Hiccups
While Charles Osborne’s case is unique, hiccups can become prolonged for various reasons. Hiccups lasting more than 48 hours are classified as persistent, while those extending beyond a month are termed intractable. The hiccup reflex involves a complex nerve pathway, or reflex arc, including the phrenic and vagus nerves. These nerves transmit signals to the diaphragm, causing sudden contraction and rapid vocal cord closure, producing the characteristic sound.
Irritation or damage to these nerves can lead to chronic hiccups. Common causes include gastrointestinal issues like acid reflux (GERD) or structural problems such as tumors or cysts pressing on the phrenic or vagus nerves. Disorders affecting the central nervous system, such as strokes, multiple sclerosis, brain injuries, or infections like meningitis, can also disrupt the brain’s control over the hiccup reflex. Metabolic imbalances, including kidney disease or electrolyte disturbances, and certain medications, such as some chemotherapy drugs or steroids, may also trigger persistent hiccups.
Managing Chronic Hiccups
Chronic hiccups can severely diminish an individual’s quality of life, leading to sleep deprivation, difficulty eating, weight loss, and social embarrassment. Medical interventions often address any identified underlying condition. Pharmacological treatments may include muscle relaxants like baclofen, anticonvulsants such as gabapentin, or antipsychotic medications like chlorpromazine, which is approved for intractable hiccups. Other medications like metoclopramide or proton pump inhibitors may also be used.
Beyond medication, various non-pharmacological approaches aim to interrupt the hiccup reflex. These methods often involve stimulating the vagus nerve, such as holding one’s breath, sipping cold water, or performing the Valsalva maneuver (exhaling forcefully against a closed airway). Less common but sometimes effective strategies include acupuncture or hypnotherapy. In rare cases where other treatments fail, surgical options may be considered, such as injecting anesthetic to block the phrenic nerve or implanting a device to stimulate the vagus nerve.