The sudden involuntary contraction of a powerful muscle called the diaphragm causes the vocal cords to shut producing the characteristic `hic’ sound of the hiccup. The diaphragm is a muscle separating the chest from the abdomen and it helps in breathing.
Causes of hiccups
1.     Most often, no cause can be determined for a hiccup. It stops as suddenly as it starts producing temporary discomfort.
2.     Drugs like diazepam, lorazepam , drugs  used to treat acidity , ondansetron used to control vomiting and others may cause hiccups as a side-effect.
3.     Hiccups commonly occur as a result of eating too fast, consuming fatty or spicy foods or swallowing a lot of air while eating. They may also occur due to having carbonated drinks or alcohol during the meal. The gas in the drink makes the stomach expand which irritates the phrenic nerve leading to hiccups.
4.     In some chronic conditions like kidney failure, diabetes, alcoholism, brain tumours involving the brainstem, liver disease, pneumonia and other lung problems, hiccups are reported.
5.     Breathing in poisonous fumes can also result in hiccups.
6.     Abdominal surgery may irritate the phrenic nerve resulting in hiccups.
Symptoms and signs of hiccups
The most obvious sign is the `hic’ sound that is heard when the hiccupping starts.
The hiccup generally subsides on its own after a few minutes but if it continues it can prevent a person from carrying out his daily activities and may cause embarrassment which can lead him to avoid going out in public and becoming an introvert.
If hiccups last for more than three hours or prevent you from getting a good night’s sleep, it is time to bring it to the attention of your doctor. If hiccups occur along with fever, abdominal pain and difficulty in breathing, go to a hospital immediately.
Diagnosis of hiccups
Most often, a hiccup is so characteristic that it cannot be mistaken for anything else. If the patient is not sure whether the sound is a hiccup, he can be observed by a health worker or doctor to confirm the same. No investigation can confirm hiccups.
Investigations of hiccups
Routine blood tests are done to check for infection, diabetes and kidney status.
If the doctor suspects a medical condition which is causing the hiccups, he may recommend investigations like a CT scan or MRI to determine the state of the diaphragm and phrenic nerve. A chest X-ray is done routinely to rule out any chest problems that may be the culprit.
The vocal cords can be visualized by laryngoscopy which is usually done by an E.N.T surgeon. Alternatively an upper gastro intestinal endoscopy (OGD scopy) may be done to visualize the food pipe and stomach.
If a problem in the brain is suspected, scans of the brain may be ordered.
Treatment of hiccups
Both home remedies and medical treatment find a place in the treatment of hiccups. Most people who get hiccups often swear by home cures which stop the hiccups completely. The idea behind these maneuvers is to increase the levels of carbon dioxide in the body and override the nerve signals that cause hiccups. Here are some mentioned.
1.     Hold your breath for as long as you can and swallow when you feel the hiccup coming. Repeat this a few times, take a deep breath and start over till the hiccups subside.
2.     Another popular remedy is to fill a glass of water, bend forwards and drink the water from the far side of the glass. Remember to drink quickly.
3.     Get hold of a brown paper bag and breathe in it. Blow in and out about ten times fast till you find your face has become red. Hold the bag around your mouth that so that no air gets in from outside.
4.     Chew crushed ice, gargle or sip ice water to get rid of hiccups.
Alternative remedies include biofeedback and meditation which will keep you calm and prevent any nervous outbursts which in turn lead to hiccups.

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