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.
