Persistent hiccups may be due to a number of causes. Identifying the cause is important in order to plan the optimum solution.


Persistent hiccups may be:

(1) prolonged (lasting for > 48 hours)

(2) recurrent despite therapy


Disorders of the central nervous system:

(1) brain tumors or other intracranial mass lesions

(2) head trauma

(3) surgery

(4) infection (meningitis, abscess, encephalitis)

(5) vascular lesions

(6) multiple sclerosis

(7) sarcoidosis


Irritation of branches of the vagus nerve (meningeal, auricular, pharyngeal, laryngeal, thoracic, abdominal):

(1) diaphragmatic irritation

(2) tympanic membrane irritation

(3) tumors in the head and neck, thorax or abdomen

(4) infections in the head and neck, thorax or abdomen


Metabolic causes:

(1) electrolyte imbalances

(2) renal failure with uremia

(3) diabetes mellitus

(4) alcohol


Miscellaneous causes:

(1) medications (chemotherapy, high dose corticosteroids, etc)

(2) psychogenic


Sometimes no precipitating cause is identified (idiopathic) but persistent evaluation may be able to eventually identify a cause.


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