Interventional spine procedures are widely used non-surgical approaches for the management of acute and chronic pain. Although usually considered safe, these procedures may still be associated with temporary and minor complications, including hiccups. In this article, we report a rare case of a 60-year-old male patient with low back pain who developed recurrent hiccups following a lumbar epidural steroid injection. In conclusion, the exact mechanism of hiccups remains unclear, and their relationship with the level of epidural injection or the specific drug mixture used is not well established. As hiccups following epidural injections have been insufficiently documented in the literature, this case aims to highlight hiccups as a potentially under-recognized adverse effect of epidural steroid injections in interventional pain management.

Hiccups (singultus) are generally benign and self-limiting conditions; however, in some patients, they may become persistent and require treatment. Although proton pump inhibitors (PPIs), chlorpromazine, and various centrally acting agents are commonly used, evidence for alternative treatment options remains limited. While PPIs are frequently utilized for hiccups that develop secondary to dyspepsia, there is limited data in the literature to support antihistamines as an effective treatment modality, and clinical data supporting their use are also limited. This case series aimed to evaluate the clinical utility and safety of the combination of intravenous pantoprazole and pheniramine, an H1 antihistamine with anticholinergic properties, in the treatment of persistent hiccups.

Although hiccups are a reflex involving diaphragmatic contraction and glottic closure, the afferent pathway involved in humans remains unclear. We report the cases of two adult patients who developed hiccups during intravenous sedation for dental procedures. In both cases, midazolam administration immediately provoked persistent hiccups. Ultrasound-guided selective glossopharyngeal nerve block with local anesthetic resulted in immediate and complete hiccup cessation, allowing the uneventful continuation of dental procedures. Both patients had previously received midazolam without experiencing hiccups, suggesting that the drug alone was insufficient to trigger the response. Hence, reflex activation by pharyngeal stimulation from saliva or secretions may be necessary. These observations highlight a potentially under-recognized afferent pathway with diagnostic and therapeutic implications. The glossopharyngeal nerve contributes to hiccup generation in humans. Therefore, understanding hiccup pathophysiology may enable the management of underlying conditions in addition to symptom relief.

Persistent hiccups are a rare but potentially debilitating complication of certain chemotherapeutic agents, particularly cisplatin, and may lead to sleep disruption, nutritional compromise, and decreased quality of life. Chemotherapy-induced hiccups are often refractory to conventional pharmacologic therapies, posing a clinical challenge in oncology care. We present the case of a 67-year-old man with moderately differentiated squamous cell carcinoma of the oropharynx who developed nearly continuous hiccups following his second cycle of cisplatin chemotherapy. Standard pharmacologic interventions, including metoclopramide, gabapentin, and a single dose of intravenous chlorpromazine, provided only transient or minimal relief. Osteopathic evaluation identified somatic dysfunctions involving the mid-cervical spine (C3-C5), upper thoracic segments, thoracic inlet, an elevated left first rib, restricted right hemidiaphragmatic excursion, and cranial base restrictions. These findings were considered potential contributors to altered diaphragmatic mechanics and dysregulation of the hiccup reflex arc. A single session of osteopathic manipulative treatment (OMT) directed at these regions was associated with rapid and complete resolution of hiccups, with sustained improvement in sleep, oral intake, and overall functional status. The patient tolerated subsequent chemotherapy cycles without recurrence of symptoms and did not require additional pharmacologic or osteopathic interventions. While causal inference cannot be established from a single case, this report suggests that OMT may serve as a safe adjunctive therapy for refractory chemotherapy-induced hiccups, potentially through effects on diaphragmatic motion, myofascial tension, and autonomic regulation.

Chronic refractory hiccups significantly impair quality of life, especially with prolonged symptom duration. This case highlights the therapeutic potential of a combined interventional approach in managing chronic refractory hiccups, particularly in patients with prolonged symptom duration unresponsive to conventional treatments. A 52-year-old man presented with a 20-year history of persistent, debilitating hiccups, often triggered after meals and resistant to pharmacological therapy. His symptoms had worsened in recent years, occasionally accompanied by reflux and vomiting, with minimal relief from anti-reflux medications and neural supplements. Further evaluation revealed pathological acid reflux and excessive supra-gastric belching, suggesting gastroesophageal reflux disease (GERD) as a contributing factor. After comprehensive assessment and informed consent, the patient underwent a series of ultrasound-guided interventions, including bilateral stellate ganglion blocks (SGBs) and phrenic nerve blocks. Although initial symptom relief was achieved, hiccups partially recurred, prompting the use of pulsed radiofrequency modulation (PNRF) of the phrenic nerve in combination with targeted analgesic injections. Following treatment, the patient experienced a significant and sustained reduction in hiccup frequency and severity, with only occasional brief relapses. Continued follow-up and additional sessions of phrenic nerve modulation resulted in further symptom control. This case underscores the effectiveness of integrating sympathetic and somatic nerve modulation, particularly ultrasound-guided SGB and PNRF, in cases of intractable hiccups. Such a multimodal, image-guided strategy may offer meaningful relief for patients suffering from chronic, treatment-resistant hiccups and demonstrates the value of personalized, interventional pain management in complex functional disorders.

Intractable hiccups, lasting over a month, can severely impair quality of life and, in rare cases, significantly limit the ability to maintain adequate oral nutritional intake. We report a 63-year-old male with a 5-year history of intractable hiccups, 30 kg weight loss (37%), muscle wasting, and functional decline. Extensive diagnostics found no clear cause, and multiple therapies failed. Severe oral intake difficulties prompted initiation of enteral nutrition via PEG with jejunal extension (PEG-PEJ), resulting in a 15 kg weight gain and functional recovery over 6 months. One year later, during a hiccup relapse, the jejunal tube was dislodged. With gastric access intact, we transitioned to gastric feeding, which was well tolerated despite persistent hiccups. This case underscores that malnutrition may be a significant and underrecognized complication in chronic hiccups, with no established nutritional strategies described. Our experience suggests gastric feeding may be feasible in such patients. Further research is needed to guide management.

Hyponatremia is a common electrolyte disturbance with well-recognized neurological and gastrointestinal symptoms. However, it rarely presents with atypical manifestations, such as persistent hiccups. We report a case of a 36-year-old woman with necrotizing tonsillitis who developed persistent hiccups 3 days prior to hospitalization. Laboratory evaluation revealed severe hyponatremia (serum sodium [Na] 122.4 mEq/L), consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Despite symptomatic treatment, hiccups persisted until serum Na levels were gradually corrected with hypertonic saline and fluid restriction. Hiccups resolved with improved Na levels. This case underscores the importance of considering hyponatremia in the differential diagnosis of persistent hiccups and highlights SIADH as a potential underlying cause.