What underlying condition can cause hiccups that won't go away?

October 1, 2025 •

4 min read

While most hiccups resolve on their own, roughly 4,000 people in the United States are hospitalized yearly due to persistent hiccups. Understanding what underlying condition can cause hiccups that last for more than 48 hours is crucial for diagnosis and proper medical intervention.

Quick Summary

This article explores the wide range of medical problems, including neurological, gastrointestinal, and metabolic disorders, that can trigger persistent or intractable hiccups. It details the causes, from irritated nerves to medication side effects, and outlines when to seek professional medical advice for this issue.

Key Points

Persistent vs. Transient: Hiccups lasting over 48 hours are considered persistent and are more likely to have an underlying medical cause than common, short-lived episodes.
Nerve Irritation: The root cause of persistent hiccups often involves irritation or damage to the vagus or phrenic nerves, which control the diaphragm's movement.
Gastrointestinal Issues: Conditions like GERD, gastritis, peptic ulcers, and certain cancers of the digestive tract are frequently implicated in long-lasting hiccups.
Neurological Disorders: Diseases affecting the brain or spinal cord, such as stroke, brain tumors, multiple sclerosis, and meningitis, can disrupt the hiccup reflex.
Metabolic Imbalances: Chronic hiccups can be a symptom of systemic problems, including diabetes, kidney disease, and electrolyte imbalances.
Medication Side Effects: Certain medications, notably corticosteroids like dexamethasone and some chemotherapy agents, can cause persistent hiccups.
When to Act: If hiccups last longer than two days, cause distress, or are accompanied by other symptoms, it is vital to see a doctor for a proper diagnosis.

Hiccups are the result of an involuntary spasm of the diaphragm, the large muscle at the base of the lungs, followed by the rapid closure of the vocal cords. This reflex, known medically as singultus, is usually temporary and benign. However, when hiccups persist for more than 48 hours, they are considered 'persistent,' and when they last longer than a month, 'intractable'. These chronic forms can be indicators of more significant underlying health issues and warrant a medical evaluation. The reflex arc that controls hiccups involves the phrenic and vagus nerves, so any condition that irritates or damages these pathways can be a potential cause.

Gastrointestinal Disorders

Problems affecting the digestive system are among the most common culprits for persistent hiccups, particularly because of their proximity to the diaphragm and the vagus nerve.

Conditions of the esophagus and stomach

Gastroesophageal Reflux Disease (GERD): Acid reflux is a leading cause of persistent hiccups. The irritation of the esophagus by stomach acid can trigger the hiccup reflex. Some studies suggest that up to 80% of persistent hiccup cases may be related to GERD.
Gastritis and Peptic Ulcers: Inflammation of the stomach lining or open sores in the lining can irritate the nerves that control the diaphragm.
Hiatal Hernia: This occurs when part of the stomach pushes up through the diaphragm, which can mechanically irritate the muscle.
Esophageal or Gastric Cancer: Tumors in these areas can press on the nerves, leading to persistent hiccups.

Other abdominal issues

Pancreatitis: Inflammation of the pancreas can trigger hiccups.
Gallbladder Disease: Problems with the gallbladder can also be a cause.
Bowel Obstruction: A blockage in the intestine can impact surrounding organs and nerves.

Neurological Conditions

Disorders affecting the central nervous system (brain and spinal cord) can interfere with the brain's control of the hiccup reflex.

Central nervous system disorders

Stroke: Lesions or damage in the brainstem, where the hiccup reflex center is located, can result in intractable hiccups.
Brain Tumors: Abnormal growths in the brainstem can compress nerve pathways.
Multiple Sclerosis (MS): This degenerative disease, which affects the central nervous system, can disrupt the signals responsible for normal diaphragm function.
Meningitis or Encephalitis: Infections and inflammation of the brain or the surrounding membranes can irritate the nervous system.
Traumatic Brain Injury: Head trauma can damage the brain areas that regulate the hiccup reflex.

Respiratory and Cardiovascular Problems

Conditions affecting the lungs and heart can irritate the diaphragm or the nerves that serve it.

Thoracic causes

Pneumonia or Pleurisy: Inflammation of the lungs or the chest lining (pleura) can directly affect the diaphragm.
Asthma: Severe asthma attacks or flare-ups can sometimes lead to persistent hiccups.
Lung Cancer: Tumors in the lung or mediastinal region can exert pressure on the phrenic and vagus nerves.
Pulmonary Embolism: This is a blood clot in the lung and, in rare cases, can cause persistent hiccups.

Heart-related conditions

Pericarditis: Inflammation of the sac-like membrane surrounding the heart.
Aortic Aneurysm: An aneurysm in the aorta (the body's main artery) can cause nerve irritation.

Metabolic and Other Systemic Issues

Underlying metabolic and hormonal imbalances can also trigger chronic hiccups.

Hormonal and metabolic imbalances

Diabetes: Poorly controlled blood sugar levels can impact the nervous system.
Kidney Disease (Uremia): A buildup of waste products in the blood due to kidney failure can disrupt nerve signaling.
Electrolyte Imbalances: Levels of key electrolytes like sodium, potassium, and calcium that are too high or low can trigger hiccups.
Liver Disease or Hepatitis: Problems with the liver can also be associated.

Medication Side Effects

Certain prescription drugs are known to cause or worsen persistent hiccups.

A list of medications that can induce hiccups:

Corticosteroids: Drugs like dexamethasone are strongly associated with hiccups, particularly in cancer patients receiving chemotherapy.
Chemotherapy Drugs: Certain agents, especially platinum-based ones like cisplatin, can be a cause.
Benzodiazepines: These sedatives, at low doses, have been linked to hiccups.
Opioids: Some pain relievers in this class can cause persistent hiccups.
Barbiturates: Another class of sedatives that can have this side effect.

Comparison of Hiccup Causes

Understanding the distinction between common, transient hiccups and persistent ones is critical for seeking appropriate care.


Feature	Transient Hiccups (less than 48 hours)	Persistent/Intractable Hiccups (more than 48 hours)
Duration	Usually minutes, resolve on their own.	Days, weeks, or even years.
Common Triggers	Eating/drinking too quickly, carbonated drinks, alcohol, spicy food, emotional stress.	Underlying medical conditions or medication side effects.
Underlying Cause	Mild, temporary irritation of nerves.	More serious damage or persistent irritation of the reflex arc.
Associated Symptoms	Typically none, or brief abdominal discomfort.	May be accompanied by other symptoms related to the underlying disease.
Recommended Action	Home remedies (holding breath, drinking water).	Seek medical evaluation if they last over 48 hours.

When to See a Doctor

While most hiccups are harmless, it is important to contact a healthcare provider if your hiccups last for more than 48 hours, are very severe, or interfere with eating, sleeping, or breathing. A doctor will conduct a thorough history, physical exam, and may order tests such as blood work, imaging (X-ray, CT scan, MRI), or an endoscopy to find the root cause. Addressing the underlying condition is the most effective way to resolve persistent hiccups. In severe cases, medication or nerve-blocking treatments may be necessary.

Conclusion

For most people, hiccups are a temporary and minor annoyance. However, if they become a persistent or intractable issue, they can indicate a variety of serious underlying health problems. The causes range from common gastrointestinal conditions like GERD to complex neurological, cardiovascular, and metabolic disorders. Furthermore, certain medications, particularly steroids and chemotherapy drugs, are known triggers. The key is to recognize when simple hiccups become a medical concern. If they last longer than 48 hours, consulting a doctor is essential for proper diagnosis and treatment. Seeking professional medical advice promptly is the best course of action to address not only the hiccups but also the potentially more serious issue they may be signaling.

Frequently Asked Questions

Gastroesophageal Reflux Disease (GERD) is one of the most common causes of persistent hiccups. The backflow of stomach acid irritates the lining of the esophagus and the vagus nerve, which can trigger the hiccup reflex.

Yes, a stroke that affects the brainstem, where the hiccup reflex center is located, can cause persistent or intractable hiccups.

Medical conditions can irritate or damage the vagus and phrenic nerves, which are involved in the hiccup reflex. These can include nerve damage from surgery, tumors in the neck or chest, and inflammation.

Yes, some medications used in cancer treatment, particularly corticosteroids like dexamethasone and certain chemotherapy drugs, are known to cause persistent hiccups as a side effect.

Yes, hiccups can be a symptom of kidney disease. In cases of kidney failure, the buildup of waste products (uremia) can affect the nervous system and trigger intractable hiccups.

For persistent hiccups, doctors typically start with a physical exam and a review of medical history. Depending on other symptoms, they may order diagnostic tests, including blood tests, imaging like X-rays or CT scans, or an endoscopy.

When the underlying cause cannot be easily treated, doctors may prescribe medications such as baclofen, gabapentin, or metoclopramide to help control chronic hiccups.

Yes, stress, anxiety, excitement, or other emotional factors can sometimes trigger episodes of hiccups, though they are more commonly associated with transient episodes.

Persistent and intractable hiccups occur at a higher rate in men than in women.