The way to a man’s hiccups…

A case of a man with unstoppable hiccups has just been published online in the medical literature. Rather unusually, it turned out they were caused by early stage Parkinson’s disease.

Parkinson’s disease is most commonly associated with movement difficulties and the public most associate it with tremor or shaking.

However, it can have a wide range of other effects (more recently, problems with cognitive functions and mental health have been recognised), although this seems to be the first time hiccups have been reported as an early symptom.

The case study is reported in the journal Parkinsonism and Related Disorders:

The patient was a 62-year-old male who had been suffering from intractable hiccups for more than 6 months. The initial intermittent nature of hiccups became continuous over time. When he was quiet, the hiccups were more prominent, although his symptoms tended to decrease when he was speaking.

The hiccups frequently interrupted his speech particularly towards the end of a sentence. The hiccups tended to disappear when he was asleep. Hiccup frequency increased with emotional stress such as anxiety and anger. The patient was depressed and socially isolated due to the embarrassment caused by his continuous hiccups.

It’s a curious case, but the paper also contains a fascinating paragraph on the causes of hiccups. One cause can be with (unsurprisingly) the organs in the chest, but another can be disruption to part of the brainstem called the medulla.

The causes of hiccup can be divided into ‘peripheral’ and ‘central’. A wide variety of peripheral conditions can cause hiccup including: gastroesophageal pathologies, renal failure, malignancies, medications, abdominal surgery and even myocardial infarction.

Central causes can result from structural or functional disorders of the medulla or various other supraspinal neural elements such as multiple sclerosis, medulla oblongata cavernoma, brainstem tumors, basilar artery aneurysm, cerebellar hemangioblastoma, dorsal and lateral medullary infarctions…

The antidopaminergic agent chlorpromazine is the only drug approved for the treatment of intractable hiccups.

I never knew there was an approved drug for difficult to control hiccups, let alone chlorpromazine, the first antipsychotic drug to be developed and widely used in the 1950s.

However, stranger treatments have been discussed in the medical literature.

Perhaps some of the finest moments in hiccup medicine have come from the small but determined literature on the use of digital rectal massage (translation: finger up the arse) as a treatment.

The abstract of 1990 article from the Journal of Internal Medicine is fantastic simply for its deadpan delivery. Needless to say, it was honoured with an IgNobel award.

Link to PubMed entry for case study.

One Comment

  1. Enterhase
    Posted March 12, 2008 at 2:49 am | Permalink

    They actually used chlorpromazine to cure intractable hiccup in a Grey’s Anatomy episode (they treat the main character’s stepmother).


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