Hiccups, medically known as singultus, are a common, generally harmless physiological event. A hiccup is an involuntary, spasmodic contraction of the diaphragm muscle, which separates the chest from the abdomen. This sudden spasm is followed by the rapid closure of the glottis, the space between the vocal cords, producing the characteristic “hic” sound. While most episodes last only a few minutes and resolve without intervention, this reflex can rarely become chronic, leading to cases of medical significance.
The Specific World Record Case
The longest recorded case of continuous hiccups belongs to Charles Osborne, a farmer from Anthon, Iowa, whose bout lasted an astounding 68 years. His condition began in 1922 and persisted until 1990, a year before his death at age 97. Osborne’s ordeal started after an accident while he was weighing a hog for butchering. Doctors later theorized that the incident caused a brain stem injury, disrupting the nerve pathway responsible for the hiccup reflex.
During the first few decades, Osborne hiccupped up to 40 times per minute, which later slowed to about 20 times per minute. This continuous spasm made daily functions challenging; he had to blend all solid food to prevent choking and learned a breathing technique to suppress the loud noise. Physicians estimated he hiccupped over 430 million times throughout his life. Mysteriously, his hiccups stopped suddenly in February 1990, just 17 months before he passed away.
Defining Intractable Hiccups
Cases of prolonged hiccups are medically classified based on their duration, distinguishing them from common, brief episodes. Acute hiccups are defined as those lasting less than 48 hours and typically resolve on their own. If the spasms continue for more than 48 hours but less than a month, they are considered persistent hiccups. The most severe classification, intractable hiccups, applies to any case that lasts longer than one month, a condition that is rare and often signals a serious underlying health problem.
Intractable cases arise from a continuous disruption of the hiccup reflex arc, a pathway involving the central nervous system (CNS) and peripheral nerves. Chronic hiccups may be triggered by irritation of the vagus or phrenic nerves, which control the diaphragm and glottis. Potential causes include conditions like gastroesophageal reflux disease (GERD), tumors in the neck or chest, or inflammation near the diaphragm. More serious causes involve the CNS, such as stroke, multiple sclerosis, or brain tumors that affect the brain stem area controlling the reflex.
Medical Interventions for Chronic Cases
When hiccups become persistent or intractable, medical evaluation focuses on identifying and treating the underlying cause. Physicians may use blood tests to check for metabolic issues or imaging tests, such as a chest X-ray, CT scan, or MRI, to look for masses or lesions on the nerves or in the brain. If a primary cause is found, such as GERD or a tumor, treating that condition often resolves the hiccups.
Pharmacological interventions aim to interrupt the nerve signals responsible for the spasm. The drug chlorpromazine is the only medication approved by the U.S. Food and Drug Administration specifically for intractable hiccups, acting as a dopamine receptor antagonist to disrupt the reflex arc. Other medications include muscle relaxants like baclofen and anticonvulsants such as gabapentin, which help calm the involuntary nerve activity. In the most extreme and unresponsive cases, non-pharmacological procedures may be considered, such as injecting an anesthetic to block the phrenic nerve, or surgical phrenic nerve ablation.