Corticosteroid injections are a common treatment for inflammation, but they can sometimes lead to an unexpected side effect: hiccups. While this reaction is uncommon, it can be highly disruptive and frustrating for the patient. The hiccups, or singultus, usually appear within hours of the injection and are typically temporary, resolving on their own within a few days. This article outlines the physiological reasons behind steroid-induced hiccups and provides immediate relief strategies, as well as guidance on when to seek professional medical help.
Understanding Why Steroids Trigger Hiccups
Hiccups are involuntary spasms of the diaphragm, the large muscle beneath the lungs, followed by the rapid closure of the vocal cords, which produces the characteristic “hic” sound. This reflex is controlled by a complex nerve pathway known as the hiccup reflex arc, consisting of sensory nerves, a central processing center, and motor nerves.
The corticosteroid medication is absorbed systemically into the bloodstream after the injection. Steroid compounds, particularly types like dexamethasone, interact with the central nervous system. Specifically, the medication may irritate the central component of the hiccup reflex arc by lowering the threshold for synaptic transmission in the midbrain.
This central irritation stimulates the phrenic and vagus nerves, which control the diaphragm’s movement. By sensitizing these nerves, the steroid disrupts the diaphragm’s normal rhythm, leading to rapid, spasmodic contractions. This effect is often related to the dose of the steroid and is a documented complication of corticosteroid use.
Immediate At-Home Relief Strategies
The most immediate and accessible strategies for stopping hiccups focus on two main physiological approaches: increasing carbon dioxide (CO2) levels and stimulating the vagus nerve. Increasing the concentration of CO2 in the blood helps relax the diaphragm by distracting the brain’s respiratory center from the hiccup reflex.
One effective method to increase CO2 involves breath-holding. Take a deep breath and hold it for 10 to 20 seconds, or as long as you comfortably can, before slowly exhaling. This brief interruption of normal breathing allows CO2 to build up in the lungs and bloodstream, often resetting the diaphragm’s rhythm. Another respiratory technique is to breathe slowly and steadily into a small paper bag, ensuring it covers only the mouth and nose, which also helps to increase the CO2 inhaled.
Stimulating the vagus nerve, which runs from the brainstem down to the abdomen, can also interrupt the hiccup cycle. This nerve is easily activated by actions in the throat and chest.
Maneuvers that activate the vagus nerve include:
- Gargling with ice-cold water for about a minute to stimulate the nerve endings in the back of the throat.
- Rapidly sipping ice water, or drinking from the far side of a glass while bending over.
- Performing the Valsalva maneuver, which involves exhaling forcefully against a closed mouth and pinched nose.
Physical maneuvers that compress the diaphragm can also be beneficial. Lie on your back and pull your knees up to your chest, hugging them firmly for a minute or two. This action applies gentle pressure to the diaphragm, which can help calm the muscle spasms.
When Medical Treatment Is Necessary
Pharmacological treatment prescribed by a healthcare provider becomes necessary when hiccups become persistent (lasting longer than 48 hours) or intractable (continuing for over a month). These medications work by targeting the central nervous system components of the hiccup reflex arc.
Chlorpromazine, an antipsychotic medication, is the only drug approved by the Food and Drug Administration (FDA) specifically for treating intractable hiccups. It suppresses the central hiccup reflex by acting on dopamine receptors in the brain. This medication is usually reserved for severe cases that have not responded to other treatments.
Other medications are frequently used off-label to manage persistent hiccups. Baclofen, a muscle relaxant, reduces the frequency of nerve impulses in the spinal cord. Gabapentin, an anticonvulsant, calms overactive nerve signals, proving useful in cases where the hiccups are neurological in origin. Metoclopramide, typically used for gastrointestinal issues, is sometimes prescribed as it can influence the nerve pathways involved in the hiccup reflex. The choice of medication depends on the patient’s overall health and the doctor’s clinical judgment.
Knowing When to Contact Your Doctor
While most steroid-induced hiccups are a temporary nuisance, it is important to know when to stop home remedies and seek professional medical evaluation. You should contact your doctor if the hiccups last for more than 48 hours, as this classifies them as persistent and indicates a need for medical intervention. Persistent hiccups can lead to significant distress, exhaustion, sleep deprivation, and difficulty eating or drinking.
It is also important to seek immediate medical attention if the hiccups are accompanied by other concerning symptoms. These include severe chest pain, shortness of breath, unexplained weight loss, or difficulty swallowing. These additional symptoms may suggest that the underlying cause is not simply the steroid injection but a more serious medical condition that requires a thorough diagnostic workup. Always inform your prescribing doctor about the hiccups, as they may need to adjust your medication or explore alternative treatments.