January 28, 2025 • 15 mins
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Hiccups, while often seen as a minor inconvenience, can become a significant health issue when they are persistent or intractable. This episode explores the science behind hiccups, their potential medical causes, and treatment options, particularly the use of gabapentin as an off-label solution.
• Discussion of the three types of hiccups: acute, persistent, and intractable
• Explanation of the hiccup reflex arc and its neurological basis
• Overview of the myriad causes of intractable hiccups, including central nervous system and psychological factors
• Introduction and definition of gabapentin, including its off-label use for hiccups
• Presentation of case studies demonstrating the efficacy of gabapentin
• Examination of potential side effects of gabapentin relative to other treatments
• Alternatives to gabapentin, including other medications and non-pharmacological home remedies
• Ethical considerations regarding off-label prescriptions and open communication with doctors
Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey everyone, welcome back for another deep dive.
Today we're going to be talkingabout something that's both
weirdly fascinating andsurprisingly complex Hiccups.
Speaker 2 (00:10):
Yeah.
Speaker 1 (00:11):
You specifically wanted to know more about
gabapentin for hiccups, so we'regoing to be unpacking all of
that with the help of thismedical journal article.
It's called Gabapentin forIntractable Hiccups in
Palliative Care.
Speaker 2 (00:24):
OK.
Speaker 1 (00:25):
Published in the American Journal of Hospice and
Palliative Medicine.
Our expert is here to help uskind of break this down.
Speaker 2 (00:31):
Yeah, thanks for having me.
Speaker 1 (00:32):
You bet Okay, get this.
The article starts by talkingabout different types of hiccups
.
Oh, Did you know that there arelike acute hiccups, persistent
hiccups and then wait for it,intractable hiccups?
Speaker 2 (00:45):
Intractable hiccups.
That sounds pretty intense itdoes sound pretty intense, right
?
Speaker 1 (00:49):
So acute hiccups are the ones we all know and
occasionally love, you know.
They last a few minutes, maybean hour, and then they're gone
as quickly as they came Right.
Persistent hiccups stick aroundfor more than two days, which
already sounds pretty unpleasant, but intractable hiccups.
Yeah, those are the ones thatlast for more than a month.
Speaker 2 (01:06):
A whole month.
Speaker 1 (01:07):
Yeah.
Speaker 2 (01:07):
I can see why someone would be searching for
solutions.
Speaker 1 (01:09):
All right.
Speaker 2 (01:10):
Those are definitely the kind that could signal an
underlying medical condition.
Speaker 1 (01:14):
Exactly so, before we get to the solutions, how about
we do a little hiccups 101?
Speaker 2 (01:18):
Okay.
Speaker 1 (01:19):
This article talks about something called the
hiccup reflex arc.
Speaker 2 (01:22):
Uh-huh.
Speaker 1 (01:23):
Can you break that down for us?
What is that?
Speaker 2 (01:25):
So basically, imagine your brain accidentally sending
a faulty signal that makes yourdiaphragm spasm.
Speaker 1 (01:33):
Okay.
Speaker 2 (01:34):
It's essentially a hiccup.
It's kind of like a tinyelectrical circuit going haywire
, but instead of powering alight bulb it's causing that
involuntary hic sound.
Speaker 1 (01:44):
So it's more than just a simple muscle spasm.
Our brains are actuallyinvolved in this.
Speaker 2 (01:48):
Absolutely.
Speaker 1 (01:49):
Okay.
Speaker 2 (01:49):
Several nerves and specific areas of the brain play
a role in this hiccup reflexarc.
And here's a fun fact thearticle mentions that 80% of the
time, hiccups affect the leftside of the diaphragm.
Speaker 1 (02:02):
What.
Speaker 2 (02:03):
Yeah.
Speaker 1 (02:03):
More.
Have you ever noticed if yourhiccups feel lopsided?
Now that you mention it, Idon't know if I've ever paid
attention.
Speaker 2 (02:10):
Yeah, it's something most people don't even think
about.
Speaker 1 (02:13):
But OK.
So we've got this complexreflex arc happening, but what
triggers it in the first place?
Why do we get hiccups?
Speaker 2 (02:20):
Well, for, like acute hiccups, it's often something
simple Eating or drinking tooquickly, gulping down a
carbonated beverage, suddenchange in temperature, even
stress or excitement.
Speaker 1 (02:31):
Oh, okay.
Speaker 2 (02:32):
These things can irritate the nerves involved in
that reflex arc and then set offa hiccup frenzy.
Speaker 1 (02:37):
That makes sense.
But what about thoseintractable hiccups?
Speaker 2 (02:40):
Right.
Speaker 1 (02:40):
The ones that last for weeks on end.
What's going on there?
Speaker 2 (02:44):
Well, here's where things get a little more
complicated and a lot moreinteresting.
The article points to over 100of intractable hiccups.
Speaker 1 (02:53):
Over 100.
Speaker 2 (02:54):
Yeah.
Speaker 1 (02:54):
Wow, that's a lot of possibility.
Speaker 2 (02:56):
It really is.
We're talking everything fromissues in the central nervous
system OK, like brain lesions,oh wow To problems with the
esophagus, stomach, evenpsychological factors.
Speaker 1 (03:07):
Wait.
Psychological factors mean likestress-induced hiccups, but
lasting for a month.
Speaker 2 (03:17):
Exactly yeah, it's called psychogenic hiccups.
The article also mentionsmedications as a potential
culprit, with some likemidazolam and dexamethasone
being known to trigger hiccups.
Oh, interesting yeah.
Speaker 1 (03:26):
So it's not always about that extra spicy burrito
or that third glass of soda.
Speaker 2 (03:30):
Right.
Speaker 1 (03:31):
These intractable hiccups can be like a real
medical mystery.
Yeah, and they're probably morethan just annoying.
Could they actually be harmful?
Speaker 2 (03:39):
You're right to be concerned.
The article mentions potentialcomplications like weight loss,
sleep disturbances, evenpneumonia in severe cases.
Speaker 1 (03:47):
Oh, wow.
Speaker 2 (03:48):
So yeah, these hiccups can have a significant
impact on someone's quality oflife.
Speaker 1 (03:52):
Which brings us to the focus of this deep dive.
Gabapentin is a possibletreatment for those tough cases.
Speaker 2 (03:58):
Yeah, let's dig into that.
Okay, yeah, sounds good.
Before we jump into specifics,though, maybe we should quickly
cover what gabapentin is.
Speaker 1 (04:05):
Yeah, great idea.
I think that will help usunderstand how it could work for
hiccups.
Speaker 2 (04:09):
Yeah, so gabapentin is a medication primarily used
for seizures and nerve pain.
Speaker 1 (04:14):
And how does that apply to hiccups?
Speaker 2 (04:17):
Well, it's not.
Fda approved specifically forhiccups.
Speaker 1 (04:20):
Okay.
Speaker 2 (04:20):
But doctors have been using it off-label with some
encouraging results.
Speaker 1 (04:24):
Off-label.
Can you explain what that means?
Speaker 2 (04:26):
Sure, off-label just means using a medication for a
condition that's different fromits original FDA-approved
purpose.
It's perfectly legal andhappens quite frequently in
medicine.
Speaker 1 (04:36):
Interesting.
So doctors are using thisseizure and nerve pain
medication for hiccups.
Speaker 2 (04:43):
Yeah.
Speaker 1 (04:43):
How does that work?
Speaker 2 (04:44):
So instead of targeting the hiccups directly,
gabapentin works by calming downthe nerves that trigger them.
Oh, okay, it essentiallyreduces those faulty signals
from the brain that are causingthe diaphragm to spasm.
Speaker 1 (04:56):
So you're basically giving those overactive nerves a
chill pill.
Speaker 2 (05:00):
Yeah, that's a great way to put it.
Speaker 1 (05:01):
I like that Okay.
Speaker 2 (05:02):
And the article we're looking at goes deep into some
case studies where gabapentinwas used to treat intractable
hiccups.
Speaker 1 (05:08):
Oh cool.
Speaker 2 (05:09):
I'm really interested to see how it worked out for
those patients.
Speaker 1 (05:11):
Me too.
Let's talk about those cases.
Were there any where gabapentinactually helped?
Speaker 2 (05:17):
Oh yeah, there were some pretty remarkable cases.
Speaker 1 (05:20):
Okay.
Speaker 2 (05:21):
One patient had been struggling with hiccups for
eight months.
Speaker 1 (05:24):
Eight months.
Speaker 2 (05:25):
Yeah, can you imagine ?
Speaker 1 (05:27):
Oh, that's awful.
I can't even imagine trying togo about daily life with like
constant hiccups.
Speaker 2 (05:32):
It definitely sounds debilitating.
Yeah, they had tried all sortsof treatments, but nothing
seemed to work.
Speaker 1 (05:37):
Oh, wow.
Speaker 2 (05:38):
Then they started taking gabapentin Okay, and
within a few weeks their hiccupssignificantly decreased.
They weren't completely gone,but it was a huge improvement.
Speaker 1 (05:48):
Wow, that's impressive.
Were there any other cases likethat?
Speaker 2 (05:52):
There were.
Speaker 1 (05:52):
Oh cool.
Speaker 2 (05:53):
The researchers described three more patients
who had been dealing withintractable hiccups for years,
years Years, not just months.
Speaker 1 (06:00):
Wow.
Speaker 2 (06:01):
And in each case they experienced significant relief
after starting gabapentin.
Speaker 1 (06:04):
That's really encouraging, but I'm curious did
the article mention how longthese patients continued taking
gabapentin?
Speaker 2 (06:17):
Unfortunately, it didn't specify the duration of
treatment.
Speaker 1 (06:20):
Oh, okay.
Speaker 2 (06:21):
But the fact that it helped people who had been
suffering for so long is prettyamazing.
Speaker 1 (06:26):
It definitely makes you wonder if gabapentin could
be a game changer for peoplewith intractable hiccups.
Speaker 2 (06:31):
Right.
Speaker 1 (06:31):
Especially when you consider that some of the other
treatments out there have prettyintense side effects.
Speaker 2 (06:36):
Yeah, definitely.
Speaker 1 (06:37):
Speaking of which, did the article mention any side
effects for gabapentin?
It did, okay.
Speaker 2 (06:42):
While gabapentin is generally considered safe, it
can cause some drowsiness,dizziness and fatigue.
Speaker 1 (06:47):
So it's not a miracle cure.
Speaker 2 (06:49):
Right.
Speaker 1 (06:49):
It sounds like the side effects are relatively mild
, especially compared to some ofthe alternatives.
Yeah, didn't the articlemention something about an
antipsychotic being used forhiccups?
Speaker 2 (06:59):
It did Really.
Chlorotramazine is actually theonly drug officially approved
for hiccups in the United States.
Speaker 1 (07:06):
An antipsychotic for hiccups?
Yeah, that seems pretty extreme.
Why would doctors prescribethat?
Speaker 2 (07:11):
It's typically reserved for severe cases of
intractable hiccups that haven'tresponded to other treatments.
Speaker 1 (07:18):
Okay.
Speaker 2 (07:19):
But, as you might imagine, it comes with a greater
risk of side effects likedrowsiness, agitation and even a
movement disorder calledtardive dyskinesia.
Speaker 1 (07:27):
That sounds pretty serious.
I can see why gabapentin wouldbe a more appealing option for
many people.
Speaker 2 (07:34):
Yeah.
Speaker 1 (07:34):
But I guess it all comes down to weighing the
potential benefits against therisks, right?
What about other alternatives?
I think I saw baclofen on thelist of medications mentioned in
the article.
Speaker 2 (07:45):
You're right.
Baclofen is another medicationthat's sometimes used for
hiccups.
Okay, it's primarily a musclerelaxant.
Speaker 1 (07:51):
Oh, okay.
Speaker 2 (07:52):
So the thinking is that it might help by relaxing
the diaphragm.
That makes sense.
Did the article mention howeffective it is?
There's not a lot of researchon baclofen specifically for
hiccups.
Oh really, one study.
The article cited only involvedfour patients, Okay, which is
too small of a sample size todraw any firm conclusions.
Speaker 1 (08:08):
Small sample size is the bane of research.
But even if further researchshowed baclofen to be effective
bane of research.
But even if further researchshowed baclofen to be effective.
Speaker 2 (08:17):
Are there any downsides?
Well, for one it can causewithdrawal symptoms if you stop
taking it abruptly.
Speaker 1 (08:21):
Oh, oh.
Speaker 2 (08:21):
And it shares some similar side effects with
chlorpromazine things likedrowsiness, confusion and even a
drop in blood pressure.
Speaker 1 (08:28):
So not ideal, especially if you're already
dealing with a serious illness.
Yeah, it seems like finding theright treatment for hiccups is
a real balancing act, weighingthe potential benefits against
the potential downsides.
Speaker 2 (08:41):
Absolutely, and that's why the article
emphasizes the importance offiguring out what's causing the
hiccups in the first place.
Right, it's not enough to justtreat the symptom.
You need to try to identify theunderlying cause.
Speaker 1 (08:52):
It's like being a hiccup detective.
Yeah, but with over 100potential causes, that sounds
like a pretty daunting task.
Speaker 2 (08:58):
It can be a challenge , yeah, but the article provides
a good framework forapproaching the diagnosis.
Speaker 1 (09:03):
Okay.
Speaker 2 (09:06):
It breaks down those 100 plus causes into different
categories.
We already talked about centralnervous system issues like
brain lesions.
Speaker 1 (09:10):
Right.
Speaker 2 (09:10):
But there's also diaphragmatic irritation Right.
Anything that irritates thediaphragm, like pneumonia or
even a surgical incision, cantrigger hiccups.
Speaker 1 (09:19):
So even something as simple as a cough could set them
off.
Speaker 2 (09:23):
Potentially, yes, interesting.
Then you have problemsoriginating in the chest, yeah,
Like mediastinal or thoraciclesions, or even issues with the
digestive system, like GERD orulcers.
Speaker 1 (09:34):
Oh right.
Speaker 2 (09:35):
And of course, there are the psychogenic causes we
discussed.
Speaker 1 (09:37):
Right.
Speaker 2 (09:38):
Stress, anxiety and even excitement can all play a
role.
Speaker 1 (09:41):
It really is amazing how such a seemingly simple
thing like a hiccup can have somany different origins.
Speaker 2 (09:49):
Yeah.
Speaker 1 (09:49):
I can see why getting a proper diagnosis is so
important.
Speaker 2 (09:52):
It's crucial.
Yeah, a doctor will consideryour individual symptoms,
medical history and any recentevents that might have triggered
the hiccups.
Speaker 1 (10:00):
OK.
Speaker 2 (10:00):
They may order tests like blood work, imaging studies
or even an endoscopy to get aclearer picture.
Speaker 1 (10:06):
So it's about more than just prescribing a pill.
It's about taking a holisticapproach, looking at the whole
person.
Speaker 2 (10:12):
Exactly.
A holistic approach, looking atthe whole person Exactly and
sometimes simply addressing theunderlying issue, can resolve
the hiccups without the need forspecific hiccup medications.
Speaker 1 (10:21):
That's reassuring to know.
So if someone is experiencingpersistent or intractable
hiccups, what's the first stepthey should take?
Speaker 2 (10:29):
The first step is to talk to their doctor.
Speaker 1 (10:31):
Okay.
Speaker 2 (10:32):
It's important not to self-diagnose or self-treat,
especially with hiccups thathave been going on for a while.
Speaker 1 (10:37):
Right.
Speaker 2 (10:37):
A doctor can determine the severity of the
situation and rule out anyserious medical conditions.
Speaker 1 (10:42):
Sounds of solid advice, so we've covered the
mechanics of hiccups.
Speaker 2 (10:46):
Yeah.
Speaker 1 (10:46):
The huge range of potential causes and delved into
some treatment options,including gabapentin and
clopramazine Right.
What treatment options,including gabapentin and
clopramazine Right?
What other insights did thearticle offer?
Speaker 2 (10:56):
Well, it also mentioned some
non-pharmacological approachesto managing hiccups.
Okay, these are often the firstline of defense for acute
hiccups Right, and can sometimesbe helpful for more persistent
cases as well.
Speaker 1 (11:07):
By non-pharmacological you mean
things people can try at homewithout medications, Exactly
Okay.
Speaker 2 (11:15):
Think of it as the home remedy, route Right.
Some of these methods aim tointerrupt the hiccup reflex arc
by stimulating the vagus nerve.
Speaker 1 (11:20):
Okay.
Speaker 2 (11:20):
For instance, holding your breath, drinking a glass
of water quickly or garglingwith ice water can sometimes do
the trick.
Speaker 1 (11:28):
I've heard of us.
My grandmother used to swear byswallowing a teaspoon of sugar.
That's a classic one, yeah.
Speaker 2 (11:33):
And while there's no scientific evidence to back up
these home remedies, they'regenerally safe to try and might
provide some relief.
Speaker 1 (11:41):
So they're worth a shot.
But if those simple techniquesdon't work or if the hiccups are
really relentless, it'sdefinitely time to seek
professional help.
Speaker 2 (11:48):
Absolutely, and that's where the article's focus
on gabapentin comes in.
Speaker 1 (11:52):
Right.
Speaker 2 (11:52):
While it's not a cure-all, it seems like a
promising option for thosereally tough cases of
intractable hiccups, especiallyfor patients who haven't
responded to other treatments orwho can't tolerate the side
effects of those othermedications.
Speaker 1 (12:06):
So it's another tool in the toolbox for doctors to
consider.
Speaker 2 (12:09):
Precisely and, with its relatively safe profile,
it's definitely worth discussingwith your doctor if you're
struggling with persistenthiccups.
Speaker 1 (12:16):
It seems like we've really unpacked a lot about
hiccups today.
Speaker 2 (12:19):
Yeah, we have.
Speaker 1 (12:20):
We've explored the intricate nerve pathways, the
surprising number of potentialcauses and even dug into some
potential solutions likegabapentin.
This has been a fascinatingdeep dive.
Speaker 2 (12:30):
It has.
Speaker 1 (12:31):
But I have one last question before we wrap things
up what happens when thesolution itself raises ethical
questions?
We've been talking aboutgabapentin as a treatment for
hiccups, but it's not actuallyFDA approved for that.
Is it even ethical for doctorsto be prescribing it this way?
Speaker 2 (12:49):
That's a great question and it's something a
lot of people wonder about.
Using medications off-labelmeaning for something other than
their officially approvedpurpose is actually quite common
in medicine.
Speaker 1 (12:59):
So it's not illegal or anything.
Speaker 2 (13:01):
Not at all.
Doctors have the authority toprescribe medications in ways
they believe will benefit theirpatients, even if it's for use
that hasn't been specificallyapproved by the FDA.
Speaker 1 (13:12):
But it seems like there must be some risks
involved.
What are the potentialdownsides of off-label use?
Speaker 2 (13:19):
One concern is that there might not be as much
research on the drug'seffectiveness and safety for
that particular off-label use.
Speaker 1 (13:26):
Okay.
Speaker 2 (13:27):
With gabapentin and hiccups, for example.
We've got those promising casestudies we discussed, but we
still need more rigorousclinical trials to really
understand how well it works andwhat the long-term effects
might be.
Speaker 1 (13:38):
So it's kind of a gray area.
There's the potential forbenefit, but also a need for
caution and carefulconsideration.
Speaker 2 (13:46):
Exactly, and that's why open communication between
the doctor and patient is soimportant.
The doctor should clearlyexplain the rationale for using
the drug off-label, discuss thepotential benefits and risks and
talk about alternativetreatment options, and the
patient should always feelempowered to ask questions and
express any concerns they have.
Speaker 1 (14:03):
It sounds like it's a partnership, not just a
prescription.
Speaker 2 (14:06):
I like that.
A partnership that's a greatway to put it.
It's about working together,doctor and patient, to make
informed decisions and find thebest course of treatment.
Speaker 1 (14:14):
Well said, Okay.
So to sum things up for ourlistener, what are the key
takeaways from all this?
What do they need to rememberabout hiccups and gabapentin?
Speaker 2 (14:24):
Here are a few things to keep in mind.
First, while hiccups areusually harmless, they can
sometimes be a sign of anunderlying medical condition,
especially if they persist.
Speaker 1 (14:34):
Don't ignore those stubborn hiccups.
Speaker 2 (14:36):
Exactly.
Second, if you're dealing withintractable hiccups, gabapentin
has emerged as a potentialtreatment option.
It's not a cure-all and it'sprescribed off-label, but it's
shown some real promise.
Speaker 1 (14:48):
And it seems to work by calming those overactive
nerves that are triggering thehiccup.
Speaker 2 (14:52):
Right, but it's really important to have a
conversation with your doctorabout the potential benefits and
risks and to explore othertreatment options as well.
Speaker 1 (15:01):
It's all about finding the right treatment for
each individual person.
Speaker 2 (15:04):
Couldn't agree more.
And finally, don'tunderestimate the power of those
simple home remedies.
They might not always work, butthey're usually safe to try and
could provide some relief.
Speaker 1 (15:14):
So true.
Well, I think we'vesuccessfully decoded the mystery
of hiccups today, from thescience behind them to the
potential of gabapentin.
This has been a fascinatingdeep dive.
Speaker 2 (15:25):
It has been Thanks for having me.
Speaker 1 (15:27):
Absolutely.
Thanks for joining us for thisdeep dive into the fascinating
world of hiccups.
Until next time.
Hey everyone, welcome back for another deep dive.
Today we're going to be talkingabout something that's both
weirdly fascinating andsurprisingly complex Hiccups.
Speaker 2 (00:10):
Yeah.
Speaker 1 (00:11):
You specifically wanted to know more about
gabapentin for hiccups, so we'regoing to be unpacking all of
that with the help of thismedical journal article.
It's called Gabapentin forIntractable Hiccups in
Palliative Care.
Speaker 2 (00:24):
OK.
Speaker 1 (00:25):
Published in the American Journal of Hospice and
Palliative Medicine.
Our expert is here to help uskind of break this down.
Speaker 2 (00:31):
Yeah, thanks for having me.
Speaker 1 (00:32):
You bet Okay, get this.
The article starts by talkingabout different types of hiccups
.
Oh, Did you know that there arelike acute hiccups, persistent
hiccups and then wait for it,intractable hiccups?
Speaker 2 (00:45):
Intractable hiccups.
That sounds pretty intense itdoes sound pretty intense, right
?
Speaker 1 (00:49):
So acute hiccups are the ones we all know and
occasionally love, you know.
They last a few minutes, maybean hour, and then they're gone
as quickly as they came Right.
Persistent hiccups stick aroundfor more than two days, which
already sounds pretty unpleasant, but intractable hiccups.
Yeah, those are the ones thatlast for more than a month.
Speaker 2 (01:06):
A whole month.
Speaker 1 (01:07):
Yeah.
Speaker 2 (01:07):
I can see why someone would be searching for
solutions.
Speaker 1 (01:09):
All right.
Speaker 2 (01:10):
Those are definitely the kind that could signal an
underlying medical condition.
Speaker 1 (01:14):
Exactly so, before we get to the solutions, how about
we do a little hiccups 101?
Speaker 2 (01:18):
Okay.
Speaker 1 (01:19):
This article talks about something called the
hiccup reflex arc.
Speaker 2 (01:22):
Uh-huh.
Speaker 1 (01:23):
Can you break that down for us?
What is that?
Speaker 2 (01:25):
So basically, imagine your brain accidentally sending
a faulty signal that makes yourdiaphragm spasm.
Speaker 1 (01:33):
Okay.
Speaker 2 (01:34):
It's essentially a hiccup.
It's kind of like a tinyelectrical circuit going haywire
, but instead of powering alight bulb it's causing that
involuntary hic sound.
Speaker 1 (01:44):
So it's more than just a simple muscle spasm.
Our brains are actuallyinvolved in this.
Speaker 2 (01:48):
Absolutely.
Speaker 1 (01:49):
Okay.
Speaker 2 (01:49):
Several nerves and specific areas of the brain play
a role in this hiccup reflexarc.
And here's a fun fact thearticle mentions that 80% of the
time, hiccups affect the leftside of the diaphragm.
Speaker 1 (02:02):
What.
Speaker 2 (02:03):
Yeah.
Speaker 1 (02:03):
More.
Have you ever noticed if yourhiccups feel lopsided?
Now that you mention it, Idon't know if I've ever paid
attention.
Speaker 2 (02:10):
Yeah, it's something most people don't even think
about.
Speaker 1 (02:13):
But OK.
So we've got this complexreflex arc happening, but what
triggers it in the first place?
Why do we get hiccups?
Speaker 2 (02:20):
Well, for, like acute hiccups, it's often something
simple Eating or drinking tooquickly, gulping down a
carbonated beverage, suddenchange in temperature, even
stress or excitement.
Speaker 1 (02:31):
Oh, okay.
Speaker 2 (02:32):
These things can irritate the nerves involved in
that reflex arc and then set offa hiccup frenzy.
Speaker 1 (02:37):
That makes sense.
But what about thoseintractable hiccups?
Speaker 2 (02:40):
Right.
Speaker 1 (02:40):
The ones that last for weeks on end.
What's going on there?
Speaker 2 (02:44):
Well, here's where things get a little more
complicated and a lot moreinteresting.
The article points to over 100of intractable hiccups.
Speaker 1 (02:53):
Over 100.
Speaker 2 (02:54):
Yeah.
Speaker 1 (02:54):
Wow, that's a lot of possibility.
Speaker 2 (02:56):
It really is.
We're talking everything fromissues in the central nervous
system OK, like brain lesions,oh wow To problems with the
esophagus, stomach, evenpsychological factors.
Speaker 1 (03:07):
Wait.
Psychological factors mean likestress-induced hiccups, but
lasting for a month.
Speaker 2 (03:17):
Exactly yeah, it's called psychogenic hiccups.
The article also mentionsmedications as a potential
culprit, with some likemidazolam and dexamethasone
being known to trigger hiccups.
Oh, interesting yeah.
Speaker 1 (03:26):
So it's not always about that extra spicy burrito
or that third glass of soda.
Speaker 2 (03:30):
Right.
Speaker 1 (03:31):
These intractable hiccups can be like a real
medical mystery.
Yeah, and they're probably morethan just annoying.
Could they actually be harmful?
Speaker 2 (03:39):
You're right to be concerned.
The article mentions potentialcomplications like weight loss,
sleep disturbances, evenpneumonia in severe cases.
Speaker 1 (03:47):
Oh, wow.
Speaker 2 (03:48):
So yeah, these hiccups can have a significant
impact on someone's quality oflife.
Speaker 1 (03:52):
Which brings us to the focus of this deep dive.
Gabapentin is a possibletreatment for those tough cases.
Speaker 2 (03:58):
Yeah, let's dig into that.
Okay, yeah, sounds good.
Before we jump into specifics,though, maybe we should quickly
cover what gabapentin is.
Speaker 1 (04:05):
Yeah, great idea.
I think that will help usunderstand how it could work for
hiccups.
Speaker 2 (04:09):
Yeah, so gabapentin is a medication primarily used
for seizures and nerve pain.
Speaker 1 (04:14):
And how does that apply to hiccups?
Speaker 2 (04:17):
Well, it's not.
Fda approved specifically forhiccups.
Speaker 1 (04:20):
Okay.
Speaker 2 (04:20):
But doctors have been using it off-label with some
encouraging results.
Speaker 1 (04:24):
Off-label.
Can you explain what that means?
Speaker 2 (04:26):
Sure, off-label just means using a medication for a
condition that's different fromits original FDA-approved
purpose.
It's perfectly legal andhappens quite frequently in
medicine.
Speaker 1 (04:36):
Interesting.
So doctors are using thisseizure and nerve pain
medication for hiccups.
Speaker 2 (04:43):
Yeah.
Speaker 1 (04:43):
How does that work?
Speaker 2 (04:44):
So instead of targeting the hiccups directly,
gabapentin works by calming downthe nerves that trigger them.
Oh, okay, it essentiallyreduces those faulty signals
from the brain that are causingthe diaphragm to spasm.
Speaker 1 (04:56):
So you're basically giving those overactive nerves a
chill pill.
Speaker 2 (05:00):
Yeah, that's a great way to put it.
Speaker 1 (05:01):
I like that Okay.
Speaker 2 (05:02):
And the article we're looking at goes deep into some
case studies where gabapentinwas used to treat intractable
hiccups.
Speaker 1 (05:08):
Oh cool.
Speaker 2 (05:09):
I'm really interested to see how it worked out for
those patients.
Speaker 1 (05:11):
Me too.
Let's talk about those cases.
Were there any where gabapentinactually helped?
Speaker 2 (05:17):
Oh yeah, there were some pretty remarkable cases.
Speaker 1 (05:20):
Okay.
Speaker 2 (05:21):
One patient had been struggling with hiccups for
eight months.
Speaker 1 (05:24):
Eight months.
Speaker 2 (05:25):
Yeah, can you imagine ?
Speaker 1 (05:27):
Oh, that's awful.
I can't even imagine trying togo about daily life with like
constant hiccups.
Speaker 2 (05:32):
It definitely sounds debilitating.
Yeah, they had tried all sortsof treatments, but nothing
seemed to work.
Speaker 1 (05:37):
Oh, wow.
Speaker 2 (05:38):
Then they started taking gabapentin Okay, and
within a few weeks their hiccupssignificantly decreased.
They weren't completely gone,but it was a huge improvement.
Speaker 1 (05:48):
Wow, that's impressive.
Were there any other cases likethat?
Speaker 2 (05:52):
There were.
Speaker 1 (05:52):
Oh cool.
Speaker 2 (05:53):
The researchers described three more patients
who had been dealing withintractable hiccups for years,
years Years, not just months.
Speaker 1 (06:00):
Wow.
Speaker 2 (06:01):
And in each case they experienced significant relief
after starting gabapentin.
Speaker 1 (06:04):
That's really encouraging, but I'm curious did
the article mention how longthese patients continued taking
gabapentin?
Speaker 2 (06:17):
Unfortunately, it didn't specify the duration of
treatment.
Speaker 1 (06:20):
Oh, okay.
Speaker 2 (06:21):
But the fact that it helped people who had been
suffering for so long is prettyamazing.
Speaker 1 (06:26):
It definitely makes you wonder if gabapentin could
be a game changer for peoplewith intractable hiccups.
Speaker 2 (06:31):
Right.
Speaker 1 (06:31):
Especially when you consider that some of the other
treatments out there have prettyintense side effects.
Speaker 2 (06:36):
Yeah, definitely.
Speaker 1 (06:37):
Speaking of which, did the article mention any side
effects for gabapentin?
It did, okay.
Speaker 2 (06:42):
While gabapentin is generally considered safe, it
can cause some drowsiness,dizziness and fatigue.
Speaker 1 (06:47):
So it's not a miracle cure.
Speaker 2 (06:49):
Right.
Speaker 1 (06:49):
It sounds like the side effects are relatively mild
, especially compared to some ofthe alternatives.
Yeah, didn't the articlemention something about an
antipsychotic being used forhiccups?
Speaker 2 (06:59):
It did Really.
Chlorotramazine is actually theonly drug officially approved
for hiccups in the United States.
Speaker 1 (07:06):
An antipsychotic for hiccups?
Yeah, that seems pretty extreme.
Why would doctors prescribethat?
Speaker 2 (07:11):
It's typically reserved for severe cases of
intractable hiccups that haven'tresponded to other treatments.
Speaker 1 (07:18):
Okay.
Speaker 2 (07:19):
But, as you might imagine, it comes with a greater
risk of side effects likedrowsiness, agitation and even a
movement disorder calledtardive dyskinesia.
Speaker 1 (07:27):
That sounds pretty serious.
I can see why gabapentin wouldbe a more appealing option for
many people.
Speaker 2 (07:34):
Yeah.
Speaker 1 (07:34):
But I guess it all comes down to weighing the
potential benefits against therisks, right?
What about other alternatives?
I think I saw baclofen on thelist of medications mentioned in
the article.
Speaker 2 (07:45):
You're right.
Baclofen is another medicationthat's sometimes used for
hiccups.
Okay, it's primarily a musclerelaxant.
Speaker 1 (07:51):
Oh, okay.
Speaker 2 (07:52):
So the thinking is that it might help by relaxing
the diaphragm.
That makes sense.
Did the article mention howeffective it is?
There's not a lot of researchon baclofen specifically for
hiccups.
Oh really, one study.
The article cited only involvedfour patients, Okay, which is
too small of a sample size todraw any firm conclusions.
Speaker 1 (08:08):
Small sample size is the bane of research.
But even if further researchshowed baclofen to be effective
bane of research.
But even if further researchshowed baclofen to be effective.
Speaker 2 (08:17):
Are there any downsides?
Well, for one it can causewithdrawal symptoms if you stop
taking it abruptly.
Speaker 1 (08:21):
Oh, oh.
Speaker 2 (08:21):
And it shares some similar side effects with
chlorpromazine things likedrowsiness, confusion and even a
drop in blood pressure.
Speaker 1 (08:28):
So not ideal, especially if you're already
dealing with a serious illness.
Yeah, it seems like finding theright treatment for hiccups is
a real balancing act, weighingthe potential benefits against
the potential downsides.
Speaker 2 (08:41):
Absolutely, and that's why the article
emphasizes the importance offiguring out what's causing the
hiccups in the first place.
Right, it's not enough to justtreat the symptom.
You need to try to identify theunderlying cause.
Speaker 1 (08:52):
It's like being a hiccup detective.
Yeah, but with over 100potential causes, that sounds
like a pretty daunting task.
Speaker 2 (08:58):
It can be a challenge , yeah, but the article provides
a good framework forapproaching the diagnosis.
Speaker 1 (09:03):
Okay.
Speaker 2 (09:06):
It breaks down those 100 plus causes into different
categories.
We already talked about centralnervous system issues like
brain lesions.
Speaker 1 (09:10):
Right.
Speaker 2 (09:10):
But there's also diaphragmatic irritation Right.
Anything that irritates thediaphragm, like pneumonia or
even a surgical incision, cantrigger hiccups.
Speaker 1 (09:19):
So even something as simple as a cough could set them
off.
Speaker 2 (09:23):
Potentially, yes, interesting.
Then you have problemsoriginating in the chest, yeah,
Like mediastinal or thoraciclesions, or even issues with the
digestive system, like GERD orulcers.
Speaker 1 (09:34):
Oh right.
Speaker 2 (09:35):
And of course, there are the psychogenic causes we
discussed.
Speaker 1 (09:37):
Right.
Speaker 2 (09:38):
Stress, anxiety and even excitement can all play a
role.
Speaker 1 (09:41):
It really is amazing how such a seemingly simple
thing like a hiccup can have somany different origins.
Speaker 2 (09:49):
Yeah.
Speaker 1 (09:49):
I can see why getting a proper diagnosis is so
important.
Speaker 2 (09:52):
It's crucial.
Yeah, a doctor will consideryour individual symptoms,
medical history and any recentevents that might have triggered
the hiccups.
Speaker 1 (10:00):
OK.
Speaker 2 (10:00):
They may order tests like blood work, imaging studies
or even an endoscopy to get aclearer picture.
Speaker 1 (10:06):
So it's about more than just prescribing a pill.
It's about taking a holisticapproach, looking at the whole
person.
Speaker 2 (10:12):
Exactly.
A holistic approach, looking atthe whole person Exactly and
sometimes simply addressing theunderlying issue, can resolve
the hiccups without the need forspecific hiccup medications.
Speaker 1 (10:21):
That's reassuring to know.
So if someone is experiencingpersistent or intractable
hiccups, what's the first stepthey should take?
Speaker 2 (10:29):
The first step is to talk to their doctor.
Speaker 1 (10:31):
Okay.
Speaker 2 (10:32):
It's important not to self-diagnose or self-treat,
especially with hiccups thathave been going on for a while.
Speaker 1 (10:37):
Right.
Speaker 2 (10:37):
A doctor can determine the severity of the
situation and rule out anyserious medical conditions.
Speaker 1 (10:42):
Sounds of solid advice, so we've covered the
mechanics of hiccups.
Speaker 2 (10:46):
Yeah.
Speaker 1 (10:46):
The huge range of potential causes and delved into
some treatment options,including gabapentin and
clopramazine Right.
What treatment options,including gabapentin and
clopramazine Right?
What other insights did thearticle offer?
Speaker 2 (10:56):
Well, it also mentioned some
non-pharmacological approachesto managing hiccups.
Okay, these are often the firstline of defense for acute
hiccups Right, and can sometimesbe helpful for more persistent
cases as well.
Speaker 1 (11:07):
By non-pharmacological you mean
things people can try at homewithout medications, Exactly
Okay.
Speaker 2 (11:15):
Think of it as the home remedy, route Right.
Some of these methods aim tointerrupt the hiccup reflex arc
by stimulating the vagus nerve.
Speaker 1 (11:20):
Okay.
Speaker 2 (11:20):
For instance, holding your breath, drinking a glass
of water quickly or garglingwith ice water can sometimes do
the trick.
Speaker 1 (11:28):
I've heard of us.
My grandmother used to swear byswallowing a teaspoon of sugar.
That's a classic one, yeah.
Speaker 2 (11:33):
And while there's no scientific evidence to back up
these home remedies, they'regenerally safe to try and might
provide some relief.
Speaker 1 (11:41):
So they're worth a shot.
But if those simple techniquesdon't work or if the hiccups are
really relentless, it'sdefinitely time to seek
professional help.
Speaker 2 (11:48):
Absolutely, and that's where the article's focus
on gabapentin comes in.
Speaker 1 (11:52):
Right.
Speaker 2 (11:52):
While it's not a cure-all, it seems like a
promising option for thosereally tough cases of
intractable hiccups, especiallyfor patients who haven't
responded to other treatments orwho can't tolerate the side
effects of those othermedications.
Speaker 1 (12:06):
So it's another tool in the toolbox for doctors to
consider.
Speaker 2 (12:09):
Precisely and, with its relatively safe profile,
it's definitely worth discussingwith your doctor if you're
struggling with persistenthiccups.
Speaker 1 (12:16):
It seems like we've really unpacked a lot about
hiccups today.
Speaker 2 (12:19):
Yeah, we have.
Speaker 1 (12:20):
We've explored the intricate nerve pathways, the
surprising number of potentialcauses and even dug into some
potential solutions likegabapentin.
This has been a fascinatingdeep dive.
Speaker 2 (12:30):
It has.
Speaker 1 (12:31):
But I have one last question before we wrap things
up what happens when thesolution itself raises ethical
questions?
We've been talking aboutgabapentin as a treatment for
hiccups, but it's not actuallyFDA approved for that.
Is it even ethical for doctorsto be prescribing it this way?
Speaker 2 (12:49):
That's a great question and it's something a
lot of people wonder about.
Using medications off-labelmeaning for something other than
their officially approvedpurpose is actually quite common
in medicine.
Speaker 1 (12:59):
So it's not illegal or anything.
Speaker 2 (13:01):
Not at all.
Doctors have the authority toprescribe medications in ways
they believe will benefit theirpatients, even if it's for use
that hasn't been specificallyapproved by the FDA.
Speaker 1 (13:12):
But it seems like there must be some risks
involved.
What are the potentialdownsides of off-label use?
Speaker 2 (13:19):
One concern is that there might not be as much
research on the drug'seffectiveness and safety for
that particular off-label use.
Speaker 1 (13:26):
Okay.
Speaker 2 (13:27):
With gabapentin and hiccups, for example.
We've got those promising casestudies we discussed, but we
still need more rigorousclinical trials to really
understand how well it works andwhat the long-term effects
might be.
Speaker 1 (13:38):
So it's kind of a gray area.
There's the potential forbenefit, but also a need for
caution and carefulconsideration.
Speaker 2 (13:46):
Exactly, and that's why open communication between
the doctor and patient is soimportant.
The doctor should clearlyexplain the rationale for using
the drug off-label, discuss thepotential benefits and risks and
talk about alternativetreatment options, and the
patient should always feelempowered to ask questions and
express any concerns they have.
Speaker 1 (14:03):
It sounds like it's a partnership, not just a
prescription.
Speaker 2 (14:06):
I like that.
A partnership that's a greatway to put it.
It's about working together,doctor and patient, to make
informed decisions and find thebest course of treatment.
Speaker 1 (14:14):
Well said, Okay.
So to sum things up for ourlistener, what are the key
takeaways from all this?
What do they need to rememberabout hiccups and gabapentin?
Speaker 2 (14:24):
Here are a few things to keep in mind.
First, while hiccups areusually harmless, they can
sometimes be a sign of anunderlying medical condition,
especially if they persist.
Speaker 1 (14:34):
Don't ignore those stubborn hiccups.
Speaker 2 (14:36):
Exactly.
Second, if you're dealing withintractable hiccups, gabapentin
has emerged as a potentialtreatment option.
It's not a cure-all and it'sprescribed off-label, but it's
shown some real promise.
Speaker 1 (14:48):
And it seems to work by calming those overactive
nerves that are triggering thehiccup.
Speaker 2 (14:52):
Right, but it's really important to have a
conversation with your doctorabout the potential benefits and
risks and to explore othertreatment options as well.
Speaker 1 (15:01):
It's all about finding the right treatment for
each individual person.
Speaker 2 (15:04):
Couldn't agree more.
And finally, don'tunderestimate the power of those
simple home remedies.
They might not always work, butthey're usually safe to try and
could provide some relief.
Speaker 1 (15:14):
So true.
Well, I think we'vesuccessfully decoded the mystery
of hiccups today, from thescience behind them to the
potential of gabapentin.
This has been a fascinatingdeep dive.
Speaker 2 (15:25):
It has been Thanks for having me.
Speaker 1 (15:27):
Absolutely.
Thanks for joining us for thisdeep dive into the fascinating
world of hiccups.
Until next time.
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