Hiccups

Hiccups are sudden, involuntary contractions of the diaphragm, the muscle that helps you breathe. These spasms are followed by a quick closure of the vocal cords, producing the familiar "hic" sound.

Although usually harmless and short-lived, hiccups are a common symptom that is often overlooked. In people with cancer, they can become persistent and disruptive, affecting eating, sleeping, and overall comfort. Studies show that up to 40% of patients receiving chemotherapy may experience hiccups, and 6–10% may develop persistent or long-lasting episodes.

Causes of Hiccups in Cancer Patients

Hiccups can occur at the most unexpected times. For people with cancer, they may happen more often and last longer than usual.

General Causes

• Eating or drinking too fast
  If you eat or drink quickly, you might swallow extra air. This can stretch your stomach and irritate your diaphragm, leading to hiccups.
• Fizzy drinks or overeating
  Carbonated beverages and large meals introduce excess gas into the stomach, which may stimulate the hiccup reflex.
• Sudden temperature changes or stress
  Drinking something cold right after a hot meal can confuse the nerves that control your breathing muscles.
• Alcohol or calming medications (like benzodiazepines)
  Alcohol and sedatives may affect the central nervous system, lowering the threshold for hiccup reflex activation.
• Emotional ups and downs
  Feeling worried, overwhelmed, or emotionally drained can affect the autonomic nervous system activity and trigger hiccups in some individuals

Cancer-Related Causes

• Chemotherapy drugs (e.g. cisplatin, carboplatin, oxaliplatin, dexamethasone)
  Some chemotherapy agents and supportive medications can irritate the gastrointestinal tract or affect the hiccup control centers of the brain.
• Opioid painkillers (e.g. morphine)
  Opioids may alter brainstem activity and slow digestion, both of which can contribute to hiccups.
• Tumors pressing on the diaphragm or nearby nerves
  If a tumor is near your chest or upper belly, it might press on the diaphragm or nerves and trigger hiccups.
• Brain tumors
  Lesions in the brainstem or areas involved in autonomic control can disrupt the normal regulation of the hiccup reflex.
• Digestive issues like bloating or acid reflux
  Anticancer treatment can cause bloating or acid reflux, which may irritate your diaphragm.
• Electrolyte imbalances
  Abnormal levels of calcium, sodium, or potassium, often due to cancer or its treatment, can affect nerve and muscle function, including the diaphragm.
• Kidney problems
  Impaired kidney function may lead to metabolic disturbances that increase the likelihood of hiccups.

Hiccups are grouped by how long they last:

• Acute hiccups – These last less than 48 hours. They’re the most common type and usually go away on their own.
• Persistent hiccups – These last more than 48 hours. They can affect your sleep, appetite, and comfort, and may need medical attention.
• Intractable hiccups – These last more than 2 months. Though rare, they can be very disruptive and often need further investigation and treatment.

If your hiccups are short-lived and not too bothersome, you can try these simple techniques at home:

• Sip cold water or peppermint water slowly
• Gargle with ice water
• Eat a piece of dry bread slowly
• Drink water with a glass while bending forward
• Take a deep breath, hold it as long as you can, and repeat several times
• Swallow a teaspoon of sugar or honey
• Suck on a lemon or drink peppermint water
• Pull your knees up to your chest and hold for a few moments
• Breathe slowly in and out of a paper bag (not plastic, and no longer than 1 minute)
• Avoid fizzy drinks and large meals
• Distract yourself with light activity, conversation, or music

If your hiccups continue or start interfering with sleep, eating, or emotional wellbeing, it’s important to speak with your healthcare team. They may recommend one or more of the following treatments:

Medications

• Baclofen: A muscle relaxant that helps calm the diaphragm and reduce spasms.
• Metoclopramide: A medication that improves digestion and reduces stomach bloating.
• Chlorpromazine: This drug can help interrupt the hiccup reflex.
• Gabapentin or Haloperidol: These may be used in certain cases, especially when hiccups are linked to nerve irritation or brain-related causes.

• Acupuncture: This may help regulate nerve signals and relieve the symptoms.
• Phrenic nerve block: It is a treatment for intractable hiccups that uses an injection of anesthetic to temporarily or continuously block the phrenic nerve, which controls the diaphragm. It may be an option for patients with terminal conditions, such as cancer, where other treatments have failed. 
• Paracentesis: If hiccups are caused by a build-up of fluid in the abdomen, draining the fluid can relieve pressure on the diaphragm and ease symptoms.

Persistent hiccups can lead to fatigue, poor sleep, reduced appetite, and emotional distress. Early intervention can make a big difference in your comfort and quality of life.