While most of us experience hiccups as a fleeting annoyance, a recent high-profile case has highlighted their potential to become a serious medical concern. Brazil's jailed former president, Jair Bolsonaro, reportedly underwent three medical procedures to halt a severe and persistent bout of hiccups. This incident serves as a stark reminder that, in rare circumstances, this common reflex can transform into a debilitating condition requiring expert intervention.
The Anatomy of a Hiccup: From Common Irritation to Chronic Condition
Hiccups are one of the few bodily functions named for the sound they produce. The distinctive 'hic' noise occurs when the diaphragm – the large, dome-shaped muscle crucial for breathing – undergoes a sudden, involuntary spasm. This contraction forces a rapid intake of air, which is then abruptly halted by the vocal cords snapping shut.
For the vast majority of people, hiccup episodes are short-lived, lasting mere minutes and resolving spontaneously. The frequency can range from two to 60 spasms per minute. Common triggers include an overfull stomach, consumption of alcoholic or fizzy drinks, extreme beverage temperatures, and emotional states like stress or excitement.
However, the medical perspective shifts significantly when hiccups persist. Episodes lasting longer than 48 hours are classified as 'persistent'. If they continue unabated for more than a month, they are termed 'intractable hiccups' – a rare but often exhausting condition that can severely disrupt eating, sleeping, and breathing.
Evidence-Based Remedies and Medical Treatments
The world is full of suggested hiccup cures, from breathing into a paper bag to biting a lemon. While many lack scientific backing, some techniques have shown promise in small studies. Effective methods often work by resetting the nerves controlling the diaphragm, either by altering breathing patterns or briefly increasing carbon dioxide levels in the blood.
One structured approach, known as 'hiccup-relief using prolonged active inspiration', involves taking a very slow, deep breath and holding it. This method demonstrated success in a study of 21 patients. Another technique, called supra-supramaximal inspiration, where one breathes in even after the lungs feel full, helped six individuals in a separate trial.
For persistent cases that defy simple remedies, medical treatment becomes necessary. Doctors often first prescribe medications like baclofen or metoclopramide. If these prove ineffective, more invasive procedures may be considered. Jair Bolsonaro underwent a phrenic nerve block, a treatment that temporarily paralyses the nerve controlling the diaphragm to stop the spasms.
When Hiccups Signal Something More Serious
While short-term hiccups are benign, prolonged episodes can sometimes be a symptom of an underlying medical issue. In Bolsonaro's case, a previous bout in June 2021 was attributed to medication prescribed after dental surgery. Certain drugs are known triggers, including corticosteroids like dexamethasone, benzodiazepines for anxiety, and some antipsychotic medications.
Intractable hiccups are rare, affecting roughly one in 100,000 people, with over 90% of cases occurring in men over 50. Research indicates that persistent hiccups can, in some instances, be an early warning sign for conditions affecting the brainstem or cancers of the oesophagus, colon, or kidneys. Studies have found that men diagnosed with persistent hiccups have higher rates of certain cancers in the following year.
Damage from abdominal surgery or trauma – Bolsonaro was previously stabbed in the abdomen – can also play a role. In the most extreme documented case, American Charles Osborne hiccupped continuously for 68 years, from 1922 to 1990.
The key takeaway for the public is clear: while hiccups are almost always a harmless inconvenience, any episode lasting several days without an obvious trigger should be assessed by a doctor. What begins as a minor irritation can, in rare cases, unveil a significant health concern requiring prompt medical attention.
