Hiccups are often regarded with wry amusement. But for some they become anything but a joke - as retired teacher Ben Lamberton discovered when he recently suffered a ten-day bout of hiccups, where he hiccupped every 15 seconds day and night.
‘One day last autumn I just started hiccupping and couldn’t stop,’ recalls the 72-year-old from South-West London, who works as a tour guide at Kew Gardens.
‘I was a bit tired - I’d been burning the midnight oil - but I was in otherwise reasonably good health, and I don’t think anything I ate or drank triggered it.’
The usual remedies - drinking water and holding his breath - didn’t work. ‘It was incredibly frustrating, and tiring too. ‘While I could still eat and drink and talk, suddenly everything revolved around my hiccups.
‘I had to stop giving my weekly tours at Kew because I was hiccuping all the time. And it was particularly difficult at night. ‘I moved to the spare room so as not to disturb my wife, but couldn’t sleep and consequently kept falling asleep in the daytime.
‘I wasn’t a fully-functioning human being during those ten days. ‘Every now and then I’d admittedly get the odd 15 or 20 minutes of relief when I’d think, ‘Wow, I’m cured!’, but they’d soon come back again.’
Ben initially found sympathy in relatively short supply for his hiccups. ‘The truth is that there’s something funny, almost ridiculous, about having hiccups and most people just tended to grin when I did it, which I found frustrating, although I’d have probably acted the same way in their shoes,’ he says.
But by the time Ben had endured his hiccups for a couple of days, his wife and family had become concerned, so he went to see a GP who, somewhat to his surprise, told him that his hiccups ‘weren’t medically significant’.
Hiccups are most often caused by an involuntary contraction of the diaphragm - the horizontal layer of muscle separating the chest cavity from the abdomen.
Contractions can be triggered by stomach acid splashing back up into the gullet (oesophagus) after eating or drinking too much too quickly -this stimulates the nerves that control the diaphragm.
Hiccups can also be caused by excessive smoking, a sudden change in room temperature, or the temperature of one’s stomach (for instance if a very hot or cold food has been eaten) - these too, affect the nerves. But the exact cause is difficult to pinpoint.
‘The fact is that it’s not very well understood exactly what causes hiccups,’ explains Professor Alastair Watson a gastroenterologist at the University of East Anglia.
‘It can be a result of direct irritation of the nerves but it can also be caused by an infection or even damage to the brain.
‘All we know is that somehow the nerve controlling the diaphragm is set off, triggering a reflex that can’t be switched off.’
Short-term hiccups - lasting no more than an hour - can usually be cured by holding one’s breath or breathing into a paper bag, since raising the amount of carbon dioxide in the blood by not taking in oxygen can sometimes put a stop to it, although it’s not clear why.
Another method sometimes used to cure hiccups is stimulating the vagus nerve (which runs from the base of the brain through the neck to the chest and abdomen) by swallowing crushed ice.
Professor Watson says the ice can break the nerve reflex spasm, in effect providing a little shock to the system. Sustained hiccups are rare - ‘so rare that many GPs are unlikely to have ever seen someone with the condition,’ he says.
This probably explains why some doctors can be unsure what to suggest if a patient with long-lasting hiccups seeks advice. ‘If you (a GP) don’t see a condition very often, you might have trouble knowing the right course of action,’ he adds.
But if someone has sustained hiccups (lasting more than 24 hours), they should most certainly ask their GP to refer them to a gastroenterologist or a neurologist, says Professor Watson.
Those with serious neurological diseases such as strokes or multiples sclerosis, or brain injuries caused, for example, by a car crash, are most susceptible to sustained hiccups.
‘If a bout of hiccups lasted for several days, I’d be concerned about a potential disease of the brain - because hiccups are a reflex action that’s over-firing, in effect short-circuiting,’ says Professor Watson, although he added that usually there would be other symptoms apart from hiccups. In very rare cases it is also possible for sustained hiccups to be triggered by a tumour.
For more serious cases of hiccups not linked to illness, drugs such as Maxolon - used more commonly for nausea - can help by interrupting messages from the nerves. Another option is a sedative, which calms the nerve reflexes, in turn, stopping the hiccups, says Professor Watson.
Happily, the cause of Ben’s hiccups appears to have been considerably less serious - and ended up being cured by something far simpler. After being told in effect ‘not to worry’ about his condition, the hiccups continued for a further week until his anxious daughter eventually referred him to a local physiotherapist.
‘She sat me down on her massage table, went around behind me and gave the most almighty squeeze, in the same way you would someone who was choking - and I stopped hiccupping,’ he recalls. ‘It was as if she blasted the hiccups right out of me.’
It’s an intriguing suggestion, observes Professor Watson. ‘The fact that his hiccups were cured by a “bear hug” suggests to me that pulling on the nerves of the diaphragm simply broke the reflex.’ Ben, it seems, was fortunate. ‘I heard of one case where someone had hiccups continuously for five weeks, which would have been very distressing,’ says Professor Watson. I don’t think hiccups are a laughing matter - it’s time they were taken seriously.’