Ugh, the dreaded hiccups. Virtually no one likes it when this pesky, annoying reflex is triggered out of the blue. What’s funny is that everyone has some sort of tips or folk remedy that they swear by. But what does really work? Is there really an evidence-based treatment for hiccups?

That question is surprisingly not easy to answer straightforwardly. Due to the fact that hiccups are generally harmless and resolve by themselves, there is little if any research that might offer evidence-based medical treatment. You also can’t ask volunteers to hiccup at command in a laboratory setting, which makes studying them even more challenging.

What’s a hiccup exactly?

In medical jargon, hiccups are sometimes referred to as singultus or synchronous diaphragmatic flutter.

Hiccups occur when the diaphragm and external intercostal muscles suddenly contract involuntarily, causing rapid inhalation. A fraction of a second later, the vocal cords close and block airflow, which is what leads to the characteristic ‘hic’ sound.

Although hiccups can sometimes start suddenly for no apparent reason, they usually happen either when eating or drinking too quickly. Basically, any sudden blockage of airflow can trigger this reflex.

Hiccups affect everyone, from babies to older adults. In fact, even fetuses as young as 8 weeks old experience hiccups — and they do so quite often, at least once every day, according to ultrasound scans.

Although scientists have floated all sorts of ideas that may explain why hiccups exist, there’s not one proven hypothesis. Hiccups may be a reflex that helps mammals get rid of extra air in their stomachs. Another idea suggests that it is an evolutionary relic from tadpole development.

How to treat hiccups

While hiccups go away by themselves fairly quickly, some may experience intractable hiccups. Charles Osborne, an Iowa farmer, started hiccuping in 1922 while weighing a hog before slaughtering it. He didn’t stop hiccuping until 1990, completing a 68-year streak.

Most people, fortunately, don’t experience such a nightmare, but some can hiccup for days — and that can be extremely annoying, to say the least. In some cases, persistent hiccups may be a sign of an underlying medical condition, which is why you should call your doctor if it persists for more than 48 hours.

There’s no shortage of folk remedies for hiccups, some of which haven’t changed since the time of ancient greeks. The problem is that we really don’t have any alternative treatments based on sound science, such as controlled medical trials.

A 2013 review of interventions for treating persistent and intractable hiccups in adults found “insufficient evidence to recommend a particular treatment for hiccups.”

“There is a need for randomised controlled studies to identify which treatments might be effective or harmful in treating persistent hiccups,” the authors added.

One of the most common folk remedies is holding your breath or breathing into a paper bag — and this one seems to work well the most consistently.

Holding your breath increases the concentration of carbon dioxide while blocking the motor pattern of the singultus.

Here are two techniques you can safely try at home:

• Breathe in and hold the breath for about 10 seconds, then breathe out slowly. Repeat this pattern three or four times. Then repeat 20 minutes later if the hiccups don’t resolve.
• Breathe into a paper bag – but do not cover the head with the bag.

Another commonly used folk remedy involves using the same actions that typically trigger the hiccups: eating and drinking. Some tips include:

• Gargling ice water.
• Sip very cold water slowly.
• Place a slice of lemon on the tongue and suck it like a sweet.
• Put a pinch of granulated sugar on your tongue and let it sit there 5 to 10 seconds, and then swallow it. The dry granules are hard enough to swallow, which activates the vagus nerve. The body doesn’t like to swallow and spasm your diaphragm at the same time.

Alternatively, you can activate certain pressure points to ease hiccups.

• This one is kinda weird, but here goes nothing: pull out your tongue, hold the tip with the fingers and tug. This supposedly stimulates the vagus nerve, easing diaphragm spasms. The vagus nerve runs from the neck to the abdomen and is in charge of turning off the ‘fight or flight’ reflex.”
• If that doesn’t work (and it usually doesn’t), you can try pressing on the diaphragm gently.
• Or press very gently on each side of the nose while swallowing.

All these methods listed above are recommended by both the U.S. Centers for Disease Control and Prevention (CDC) and the British National Health Service (NHS), so they’re not exactly just “old wives’ tales”.

If nothing else seems to work, and the persistent hiccups negatively affect a patient’s life (unable to eat, losing weight, poor sleep, signs of depression) doctors may sometimes prescribe medication as a solution of last resort. Some of these drugs relax the muscles (Baclofen) or treat neuropathic pain (Gabapentin), nausea (Metoclopramide, Reglan), or psychotic episodes (Haloperidol).

Orgasms and rectal massage

The scientific literature surrounding hiccups is woefully lacking, but there are some interesting case studies out there. One such study involved a man whose hiccups lasted for four days, but these immediately went away after he had an orgasm following intercourse.

I’ve saved the weirdest one for last, though. Another man also had ongoing hiccups and only found relief after a rectal massage.

The best cure is prevention

Persistent hiccuping can be extremely annoying, so do yourself a favor by taking basic precautions so this happens as rarely as possible. Some tips include:

• don’t eat or drink too much or too quickly.
• avoid carbonated drinks, alcohol, and spicy foods.
• avoid as much as possible being exposed to sudden changes in temperature.
• avoid feeling too stressed or emotionally excited.