Sports legend Bo Jackson, 60, says he has experienced hiccups since last July. His doctors aren’t entirely sure why.
Hiccups lasting more than a month are known as intractable hiccups. Experts think intractable hiccups can be caused by disease, trauma, injury, cancer, or other issues.
Intractable hiccups can lead to insomnia, fatigue, weight loss, and even death.
According to recent news reports, sports legend Bo Jackson, 60, has experienced hiccups for almost an entire year. “I’ve had the hiccups since last July, and I’m getting a medical procedure done at the end of this week, I think, to try to remedy it,” Jackson said in an interview with McElroy and Cubelic in the Morning on WJOX 94.5 FM. There is currently no update regarding Jackson’s condition.
His hiccups seem to have confounded his medical specialists. “I’m busy at the hospital sitting up with doctors poking me and shining lights down my throat, and probing me every way…to find out why I’ve got these hiccups,” he said in the interview.
“I have done everything,” Jackson added, saying he’s tried drinking water upside down (which is thought to provide glottic stimulation) and being frightened (which is thought to stimulate the Vagus nerve). However, these remedies didn’t work.
Hiccups (hiccoughs or singultus) come from a sudden, involuntary contraction of the diaphragm and intercostal muscles. An abrupt, rapid closure of the glottis follows the contractions and produces a “hic” sound.
Recent research published in BMJ Open Gastroenterology shows that hiccups—and their remedies—are still a bit of a mystery in medicine: “[T]he pathophysiology of hiccups and the mechanism by which any of these methods work are unclear,” the authors write.
“There is no cut and clean way to find the exact cause of hiccups,” Ali Seifi, MD, author of the above research article; professor of neurosurgery and neurocritical care at the University of Texas Health Science Center San Antonio and creator of HiccAway, a device that relieves acute hiccups, tells MDLinx. “But hiccups don’t just come out of nowhere. Acute hiccups may be caused by either a chemical (like spicy food) or a mechanical trigger (like air swallowed with food). Most of the time, these irritations go away.”
A look at persistent and intractable hiccups
Hiccups are typically transient, but “hiccups that last from 48 hours to one month are called 'persistent hiccups,' and hiccups lasting longer than one month are termed 'intractable hiccups,’” Seifi says.
According to Current Neurology and Neuroscience Reports, intractable hiccups “can occur more often than we realize and present to multiple medical disciplines.” In fact, hiccups cross multiple fields of medicine, including neurology, gastroenterology, pulmonology, and primary care.
Intractable hiccups, Seifi says, may also be caused by a constant chemical or mechanical irritation. “They could also be due to trauma, an accident, or a surgery that affects the phrenic nerve.” For example, “sometimes surgery can entrap terminal branches of the phrenic nerve.” Note that the phrenic nerve plays a key role in the hiccup reflex.
The National Library of Medicine also says that many diseases—from cardiovascular disorders and conditions of the central nervous system to gastrointestinal issues and ear, nose, and throat disorders—can cause hiccups. Rare cases of psychogenic intractable hiccups have been documented, according to the Journal of Taibah University Medical Sciences. Seifi adds that cancer can also cause hiccups.
Generally, there are a variety of medications used to treat intractable hiccups, ranging from baclofen, gabapentin, anticonvulsants, and dopamine-blocking medication. However, finding the root cause is key, Seifi says, as chronic hiccups require treatment. The International Journal of Surgery Case Reports states that intractable hiccups can lead to “insomnia, anorexia, fatigue, exhaustion, weight loss, depression, opening of surgical wounds, development of hernia and hemorrhoids, inability to undergo imaging such as MRI and even death.”
One case report in Medicine described a “58-year-old hypertensive woman diagnosed with acute posterior circulation stroke who presented with persistent hiccups, sinus arrest, and post-hiccup syncope.” The patient’s persistent hiccups were caused by “infarction of the left middle cerebellar peduncle and the right occipital lobe,” resulting in death due to “aspiration pneumonia and the negative effects of persistent hiccups.”
What can a physician do for a patient with persistent or intractable hiccups?
Seifi recommends ruling out the causes of hiccups. He recommends running tests for electrolytes and liver workups and a urinalysis for patients who have had hiccups for a month. For patients with hiccups for over a month, “check for cancer, as most of the cancers within the abdomen are a reason for chronic hiccups. Check for a history of trauma to the chest or if they had surgery on their abdomen or close to diaphragm.”
Seifi adds that he’s seen patients with diabetes who have persistent hiccups because their glucose is too high. More so, he noted that COVID-19 can present with persistent hiccups that only resolve when the patient returns to total health.