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How far would you go to cure hiccups? Dr Karl puts his finger on a technique that really works.

Drinking water won’t cure your hiccups, but Dr Karl has found a technique that will (Source: mammamaant/iStockphoto)

Last time, I introduced you to a certain Dr Francis M Fesmire, and his patient who’d been hiccupping for at a rate of 30 per minute for some 72 hours.

Dr Fesmire came up with what is still one of the best hiccup cures around. But, before I explain what it is let me give you a quick refresher on the nuts and bolts behind how hiccups pop into their ever-so annoying existence.

A whole bunch of muscles have to fire off around the body during a hiccup, and one special nerve, the vagus nerve, is deeply implicated.

The Latin word ‘vagus’ meaning ‘wandering’ and the vagus nerve truly wanders over the body. (“Vagus” also gives us the English words, “vagrant”, “vague” and “vagabond”).

The vagus nerve starts in the brain, and then leaves the head. It travels into the chest cavity where it is involved with the lungs and heart, and deep into the gut cavity from the very top (near the mouth) to the very bottom (near the bottom). The vagus nerve coordinates swallowing and breathing, and it even runs the vocal cords.

The hiccup starts in the spinal cord in what seems to be a hiccup reflex control centre between the third and fifth cervical segments.

The vagus nerve comes into this hiccup reflex control centre, and another nerve leaves it. Electrical impulses travel down this second nerve to the diaphragm and tell it to contract, making you breathe in. Other electrical impulses go to muscles that are involved in breathing out, and switch them off. About 35-thousandths of a second after the air starts flowing in, an electrical signal is sent to the vocal cords, making them snap shut. And voil, a hiccup is felt and heard.

One moderately reliable treatment for hiccups involves deliberately overstimulating the vagus nerve, which will block other signals to the vocal cords.

So, knowing this, our Dr Fesmire started trialling a repertoire of manoeuvres well known to stimulate the vagus nerve. The first one was setting off the gag reflex by touching a tongue depressor to the back of the throat unfortunately, it did nothing to help his patient’s hiccups. Neither did pulling on his tongue.

The next step was the Valsalva manoeuvre where you try to blow air out from your lungs while you block your mouth and nose. This actually did slow the hiccups down from 30 per minute to 15 per minute but only while actually performing the manoeuvre. As soon as the patient finished the Valsalva manoeuvre, the hiccup rate went back to 30 each minute.

It was the same tantalising result for both massaging the carotid sinus in the side of the neck, and for physically compressing the eyeball with the fingers. In each case, there was a brief slowing, followed by return to the original hiccup rate.

But then Dr Fesmire sudddenly remembered reading a paper the previous year with the title of Termination Of Paroxysmal Suprventricular Tachycardia By Digital Rectal Massage. (Paroxysmal suprventricular tachycardia involves the heart accelerating up to 200 beats per minute, and it can be very uncomfortable shortness of breath, chest pain, dizziness, loss of consciousness, etc).

Now both the heart and hiccups are affected by the vagus nerve. Dr Fesmire decided that if this unconventional treatment (digital rectal massage) worked for the heart, it might work for hiccups.

As Dr Fesmire writes, “Digital rectal massage was then attempted using a slow circumferential motion. The frequency of hiccups immediately began to slow, with a termination of all hiccups within 30 seconds. There was no recurrence of hiccups during the next 30 minutes and the patient was discharged without further work up”.

Why did this work?

According to Dr Fesmire: “The rectum is supplied with an abundance of sympathetic and parasympathetic nerves, and the digital rectal massage would lead to increased vagal tone and potential termination of hiccups”.

Sensation from the rectum travels through these parasympathetic nerves and they are very sensitive to pressure.

After reading this report, Dr Odeh from the Bnai Zion Medical Center in Haifa, in Israel found that this same technique worked to fix the hiccups of a 60-year-old man with acute pancreatitis. He then went on to use this technique successfully in five other patients with intractable hiccups.

In 2006, Dr Fesmire was honoured for his discovery with the IgNobel Prize in Medicine at a ceremony at Harvard in Boston.

He later told the New Scientist magazine of another treatment likely to be more popular with the hiccuping patients. “An orgasm results in incredible stimulation of the vagus nerve. From now on, I will be recommending sex culminating with orgasm as the cure-all for intractable hiccups.”

But first, check with your health insurance provider to see if you’re covered

Tags: anatomy

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Published 04 September 2012

2012 Karl S. Kruszelnicki Pty Ltd

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04 Sep 2012 7:03:43pm

Hold breath for approx 1 minute, works I have found on myself and all others recommended to.

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22 Sep 2012 12:34:57pm

Best cure is to block yr ears (I use my fingers!) & have a big sip of water (non fizzy beverage of any kind) with ears shut. If doesn’t work first time probably not enough water swallowing, try again with bigger mouthful. Works for me & everyone I have told about it.

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05 Sep 2012 10:46:57am

I wonder if having the patient cough loudly and strongly for 30 seconds or so might work as well.

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05 Sep 2012 12:44:26pm

“.. From now on, I will be recommending sex culminating with orgasm as the cure-all for intractable hiccups.”

Is DIY OK too?

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06 Sep 2012 11:27:11pm

Ha ha, nice.

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05 Sep 2012 2:23:30pm

10 slow gulps of water without stopping has always worked for me…..

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06 Sep 2012 12:01:45am

I concur. Sipping water very, slowly, barely swallowing has always worked for me and others.

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06 Sep 2012 12:46:45pm

Merely drinking water from the “other side” (opposite side to “usual”) of a glass has never failed me!

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09 Sep 2012 10:14:41pm

Agreed! It works every time!

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10 Sep 2012 8:47:12pm

Works every time since i was a kid,and i’m now in my 70’s.I’ve given acupuncture to one of my patients who’d been hiccupping for many days and it worked within a few minutes also.

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09 Sep 2012 10:03:29pm

Same here, Kate. And much easier to do in public than rectal massage πŸ™‚

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05 Sep 2012 6:40:09pm

I was introduced, by an Irish girl in Nigeria, to the technique of having someone hold my pulse on the wrist, and both parties concentrating on it. Works every time. On occasion I can even make it work for myself, if there’s no one else around. No-one else I know has ever heard of it, but it works for others too, so no faith required.

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10 Sep 2012 12:34:57am

This is the acupuncture point pericardium 6. Known to calm the diaphragm.

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05 Sep 2012 6:45:55pm

I have found saying a word like “welcome” is quite effective. It’s better if the word is suggested by another person. But I think I’ll be using this new method from now on.

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05 Sep 2012 6:51:46pm

My cure……1 teaspoon of vinegar and presto!!!!!!
hiccups cured 100% of the time.

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05 Sep 2012 6:57:01pm

I think the embarrassment of receiving a “Digitally recorded message” was the reason why it worked. Now if only one can get the attractive nurse to perform this simple procedure…

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05 Sep 2012 7:01:18pm

just swallow a few times it works everytime for me .

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05 Sep 2012 7:53:52pm

Play the flute, or any other wind instrument.

Or drink a glass of water upside down. We did this as kids.

Basically, anything that controls, stops or strongly regulates your breathing.

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05 Sep 2012 8:28:53pm

Have someone clap you on the back between the shoulder blades very hard (especially if you aren’t expecting it) works well 99% of the time for me.

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05 Sep 2012 8:30:30pm

Hmmmm…..this sex thing….I discovered a very effective cure for hiccups many years ago but have been told it is too “socially unacceptable” to bring to anyone’s attention. It is the act of Oral Sex either giving or receiving (esp giving) that does the trick.
I suppose it fits into that same category of stimulating the “vagus”…hey that’s some terminological coincidence…yes?..esp considering that the Cervix is involved also….as mentioned in the article.
I expect the boffins may want to chew the fat on this one (sorry…couldn’t resist the gag…sic).
However, concern over the potential implication of combining both cited options as suggested in the article must be starting to be realised. I appreciate that this posting may help to lubricate the thoughts & discussion at the seat of the matter.
Either way, it may at least leave someone with a twinkle in their eye & a smile on their face.

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05 Sep 2012 8:40:20pm

Grandma knows best, half a teaspoon of brown vinegar sipped slowly, works quickly everytime.

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05 Sep 2012 8:51:20pm

Eat a banana!
We find it works immediately, every time.
Haven’t tried it on long term sufferers, though.

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05 Sep 2012 9:16:28pm

I am quite into hiccups.
Personally, I can easily induce an attack of hiccups by eating very hot chilli. It sort of makes my throat spasm which soon (within a minute or two) turns to normal old hiccups.
I can just as easily stop any hiccup event. My method also works on everyone that I have ever seen try it.
It is “drinking water from a glass while bent double”:
Half fill a glass with water. Place the back of the rim under your top lip (your chin should be sort of in the top of the glass. Bend forward from waist or hips as far as you can, keeping the glass level and insude your top lip the whole way. With your head down by your feet (bent double) slowly tilt the glass until water flows into (the top) your (upside down) mouth. Slowly swallow a few mouthfuls. Peristalsis moves the water “up” your oesophagus.
Hiccups are now gone.
Maybe the vagus nerve detects this unusual motion and stops the hiccup reflex… Try it, it works!

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05 Sep 2012 10:07:49pm

This always works. Put your fingers in your ears and your thumbs on your nose to stop yourself breathing. Have a friend hold a glass of water to your mouth which you must drink from the other side of the glass. Difficult but can be done. Hiccups go!!

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07 Sep 2012 6:15:19pm

This my preference too but I hold a full breath while drinking and upright the normal way which is much easier. After drinking at least 4 ounces nonstop I slowly blow out the air I have been holding and I feel the pressure rising up my chest and then it’s gone.

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10 Sep 2012 9:59:41am

@Ideflitch my wife uses the same method (only she takes three sips of water while holding her nose and blocking her ears). I have helped her perform this maneuver more than a dozen times, and if she does it properly, that is, if she doesnt laugh, it works every time. I was suprised because I thought there was no such thing as a cure for the hiccups. Maybe someone should tell Dr. Carl…

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05 Sep 2012 11:39:06pm

I cannot wait to get hiccups. The cure sounds absolutely intriguing.

Ehhh… does anyone know how to get hiccups?

Does anyone have hiccups…..???

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05 Sep 2012 11:54:51pm

I always found a teaspoon of vinegar makes the hiccups go away.

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06 Sep 2012 5:37:12am

I have found that drinking a glass of water ‘backwards’ always works for me. So. . . lean over til you can feel the ‘wrong’ side of the glass and start drinking, bending further and further forward til at the last gulp your head is almost between your kness. Stay down for a count of ten; then rise and all is fixed.

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10 Sep 2012 4:28:05pm

Same here …

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06 Sep 2012 7:31:11am

I’ve posted before my technique of breathing in deeply until lungs full, but continue breathing in until a full yawn occurs, but continue to breath in through the yawn until a second yawn occurs, exhale slowly, hiccups gone!

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06 Sep 2012 9:35:29am

If you have listened prev podcast, dr Karl said that what works for one person doesn’t always work for other. I found it myself that depending on the day one techinque works over the other.

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06 Sep 2012 1:00:12pm

Hi Mia. I’m sure you are correct. However, I’d love some feedback on my technique. It is none invasive, requires no drugs, no finger up the bum, just a natural yawn. Has ALWAYS worked without fail.

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06 Sep 2012 10:47:47am

Sounds more fun than my old method, but I found this works too. With a mid sized glass of water, count between hiccups, if say 10 then next time count to 9 then start drinking the water(or other) continuously swallowing until the glass is empty. This always works as I think it resets the swallow reflex. Try it

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06 Sep 2012 12:58:42pm

I think this technique works because of the same principle I described earlier. By drinking slowly, you are actually holding your breath. But drinking slowly will be less effective than holding the breath through a yawn!!

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26 Sep 2012 3:38:10am

Very interesting your technique, I was wondering if anyone had one related to mine, as it is a guarantied cure for me. As a kid I found if I breathed in as deeply as I could, then “gulped” air, forcing additional air into my lungs and expanding my chest until adding any more would be painful or possibly not advisable. Then holding it as long as I could,
usually repeat this once or twice, and voila hiccups gone. No usually gone or might be gone. But gone, gone every time such that hiccups where never a bother as I could always rid myself of them. The trick is being able to quickly force enough of the air in, that which is beyond the ability of the usual breathing mechanism. With the lungs this full, a hiccup can’t even physicaly be generated as no more air can be taken in, a prerequisite. This was always the problem to see if it worked with others as I could never explain it well enough that someone else could do it. But writing this has helped me figure out better the mechanics of “gulping” air. As simply as I can, you use the muscles attached to the hyoid bone to move it up and down, like a pump. Taking air in when it is pulled down, closing the mouth, then reducing the volume in your mouth and throat by using the, my guess, digastric and stylohyoid muscles to pull it up and back. This reduces the volume and forces that air into your lungs. This can be done rapidly, inflating your lungs to thier max. Its interesting about the Vasus nerve and its location in the and chest and the role it plays. It makes much better sense to me now as to why it works. Anyway sorry for the long windedness, but that’s my trick. Hope it helps someone. . . πŸ˜€

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06 Sep 2012 11:29:00am

Very interesting Dr Karl.

I am wondering if I should suggest this method of massage to my cardiologist in lieu of his awful treatment for chronic AF.

But wait, you may have stumbled upon the secret of the lonely long-distance runner. An electric butt-plug. No?

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06 Sep 2012 11:39:19am

Holding breath, deep breathing, slowly drinking water, drinking from the opposite side of the cup, getting a fright all have some merit. BUT a teaspoon of sipped vinegar has almost always worked, although one particularly bad bout needed a desert spoon. If this doesn’t stop them straight away, breathing in through the mouth to let some fumes into your lungs seems to do the trick. Not all that nice to take but has every time worked for me, and everyone I have ever advised. I wouldn’t give vinegar to small kids. Maybe vinegar affects that nerve??

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06 Sep 2012 11:56:28am

I had a bout of hiccups lasting 5 hours before I could see my GP. He prescribed Largactil (once used in Mental Hospitals as a tranquiliser). The hiccups vanished a few minutes after the first pill.

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06 Sep 2012 2:45:15pm

I find very effective if I raise my left arm over my head and dring slowly a glass of water. Tried many times and worked.

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09 Sep 2012 10:23:35pm

I had a work mate come up to me after I’d been hiccupping for 30 mins or so and they said to me “I’ll give you $20 if you can hiccup one more time”. Do you think I could? Nope. Cured instantly. 2 weeks later I was home alone and got them again. I said to myself I will giver her $20 if I can hiccup again…and I couldn’t. It’s a great method so is it mind over matter??

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07 Sep 2012 12:28:11pm

Um…doesn’t anyone else find it strange that Dr Fesmire equates digital rectal massage with sex culminating with orgasm?

I don’t know anyone who orgasms from direct anal massage. What an odd thing to say.

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29 Sep 2012 5:14:49am

Oh yes, oh yes, oh yes,…. πŸ˜‰ I wondered that too.

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07 Sep 2012 4:43:45pm

Suck on a wedge of lemon. 100% foolproof.

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08 Sep 2012 12:49:55pm

My cure for hiccoughs:
1. Exhale all air out of lungs.
2. Hold for ten seconds.
3. Inhale air slowly.
4. Breathe normally.

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08 Sep 2012 2:29:23pm

I have an old remedy that my late grand dad told me, it was to sip a little vinegar or suck on a wedge of lemon and hey presto no more hiccups, now just the mention of vinegar or lemon works for me and my family.

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08 Sep 2012 7:09:57pm

Eat a table spoon of lingonberry jam. It cures drunken hiccups.

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09 Sep 2012 9:22:10am

A teaching colleague told me a cure for hiccups and it never failed during my long teaching career.I would simply offer to pay the affected child
10c for the next hiccup. Never once did I have to pay!

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09 Sep 2012 9:29:48am

My hiccup cure also works for adults, but you need to offer something the person really, really wants, so be careful!

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09 Sep 2012 5:27:15pm

I prefer the final method (orgasm) to all the others proffered. Multiple benefits.

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09 Sep 2012 10:00:05pm

A shot of straight red cordial! Sweet, but always works.

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09 Sep 2012 10:21:22pm

Very interesting Dr Karl. I find drinking some water upside down always works. But I am curious about why so many other completely different techniques work. I don’t think this is a placebo effect, I’ve tried other things and they didn’t work for me. You don’t cover the initial cause of the hiccup: what is the trigger? If it is some perceived issue in the oesophagus then perhaps the wild and strange techniques produce an unusual sensation that ‘clears’ the hiccup signal condition. How to test it though? And I’m not volunteering.

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09 Sep 2012 10:43:36pm

My grandmother used the following method and it has always worked for me ( I know it sounds silly) …. Place a plastic cup of water between teeth and put fingers in both ears and drink whole glass slowly …. this equalizes the pressure …. (I use the fingers rather than stuffing cotton wool in the ears). Can I get the Nobel prize for this cure ??

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10 Sep 2012 10:07:44am

Another vote for drinking water out of the wrong side of the glass. Works every time. You have to concentrate and breathe slowly as you do it but it may also be something to do with the water going via the roof of your mouth. Was this included in the study or did they go straight to the old butt fiddling manouvre?

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10 Sep 2012 2:34:02pm

Almost all cures come down to this: “Do something that takes your mind off the hiccups for a few minutes.” The cure for most people is simply the passage of time. Whatever you were last doing when they went away will be assumed to be the “cure”. This is an example of confirmation bias.

If you don’t believe me, do the experiment. See how long hiccups take to go away with no treatment, then with treatment. Write it down. Repeat 10 times each. Then your method will have some data to back it up. Until then, your favourite cure is just a theory with a lot of faith behind it.

What Dr Karl is talking about are protracted (last for 48 hours or more) or intractable hiccups. After having hiccups for such a long time, I’m sure these people would have tried every cure on the Internet to try to get rid of them – and failed.

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10 Sep 2012 9:08:35pm

Try hitting against a wall a few times. I swear it works!

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11 Sep 2012 2:30:07pm

There’s an old bartenders remedy for hiccups which is to have a shot of grenadine. I’ve also had success with other sweet, sticky liquids. Any ideas why?

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12 Sep 2012 7:40:15am

Take a glass of fluid and drink from the other side of the glass ,you need to be standing then bend over and drink slowly from the opposite side to normal, it has worked for me for the past 50 yrs.

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14 Sep 2012 9:41:22am

I suffer from hiccups very often, At times they last for days.

I’ve seen number of GPs, a cardio thorasic surgeon,undergone tests and scans to find nothing wrong.

I’ve been trying every method I’ve heard of to stop the hiccupping as it could be very very uncomfortable. Especially when you are hiccupping for long time, in office etc…

Im sure going to try the methods discussed here!

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14 Sep 2012 10:47:00am

A mild shock, fright or being startled often works in my experience. I have cured hiccups in other people by suddenly clapping my hands close to their face, suddenly jumping up and shouting, and even asking them about “that $300” I lent them 6 months ago. I dare say the rectal massage might be startling enough to qualify as a mild shock!

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23 Sep 2012 4:54:11pm

What I do is I Hold my breath for 2 secs just before and after I hiccup.

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28 Sep 2012 9:26:14pm

Eating a teaspoonful of sugar has (almost) always worked for me and others I’ve suggested it to. I’d say it’s to do with the chewing action that you must do when you put it in your mouth, as you can’t just swallow it. Probably blocks the air and / or distract the body like in many other solutions.

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04 Oct 2012 6:24:32pm

Our family cure is similar to some others but much easier to execute. Take a deep breath and slowly drink a glass of water through a straw while blocking both ears with your fingers. Then exhale slowly. You do need the fingers, and it’s never been known to fail!

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08 Oct 2012 9:09:13pm

Stop wasting everyones time … It’s finger in the bum or nothing

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