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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Neurology

Diagnostic Workup: Finding the Hidden Cause

At a Glance

The diagnostic workup for chronic hiccups aims to find the physical irritation triggering the reflex. This typically involves brain MRIs to check the brainstem, endoscopies to evaluate the chest and stomach nerves, and blood panels to rule out metabolic or kidney imbalances.

Finding the cause of chronic hiccups is like solving a medical mystery. Because the “hiccup circuit” passes through so many parts of the body, your medical team will likely perform a series of tests to check your brain, chest, abdomen, and blood chemistry [1][2].

The goal of this diagnostic workup is to identify any physical irritation or “organic” cause that is triggering the reflex.

Step 1: Mapping the Brain and Nerves

Since the “control center” for hiccups is located in the brainstem, neuroimaging is a critical first step.

  • Brain MRI (Magnetic Resonance Imaging): This is the most detailed way to look at the medulla oblongata (the lower part of the brainstem) and the spinal cord [3]. Doctors look for signs of inflammation, small lesions, or structural issues like a Chiari malformation, which can put pressure on the nerves that trigger hiccups [4][5].
  • CT of the Torso: A Computed Tomography (CT) scan of your chest and abdomen may be ordered to look for anything that might be irritating the phrenic or vagus nerves [1]. This can include enlarged lymph nodes, infections like pneumonia, or even issues with the gallbladder or liver [6][7][8].

Step 2: Evaluating the Chest and Digestive System

Because the vagus nerve runs through your chest and right alongside your esophagus and stomach, this area is a common source of hiccup triggers.

  • Upper GI Endoscopy: A doctor (usually a gastroenterologist) uses a thin, flexible tube with a camera to look inside your esophagus and stomach [1]. They are looking for signs of severe acid reflux (GERD), ulcers, or conditions like achalasia (where the esophagus has trouble moving food toward the stomach), all of which can keep the hiccup reflex firing [9][10].
  • Electrocardiogram (ECG/EKG): Doctors will often check your heart to rule out conditions like pericarditis (inflammation of the heart lining) or even atypical heart attacks, which can dangerously irritate the vagus nerve and present with intractable hiccups [11][12].

Step 3: Checking the Blood Chemistry

Sometimes the “irritant” is not a physical growth or inflammation, but a chemical imbalance in your blood that affects how your nerves fire.

  • Metabolic Panel: This blood test checks your kidney function by measuring BUN (blood urea nitrogen) and Creatinine. High levels, a condition called uremia, are a known trigger for violent hiccups [13][14].
  • Glucose and Thyroid Tests: Doctors will check your blood sugar to rule out Diabetic Ketoacidosis (DKA) and may test your thyroid levels, as an overactive thyroid (thyrotoxicosis) has been linked to intractable hiccups [14][15][16].

A Note on “Psychogenic” Hiccups

In some cases, if all medical tests come back clear, a doctor might suggest the hiccups are “psychogenic” (caused by stress or psychological factors). However, it is vital to know that psychogenic hiccups are a diagnosis of exclusion [17].

This means that a psychogenic cause should only be considered after a thorough, multidisciplinary investigation has ruled out every possible physical trigger [17]. One helpful clue is whether the hiccups continue during sleep: hiccups that persist while you are asleep are almost always caused by a physical (organic) issue rather than a psychological one [1][11]. You can use this fact to advocate for continued medical investigation if you feel your symptoms are being dismissed.

Common questions in this guide

Why do I need a brain MRI for chronic hiccups?
The control center for the hiccup reflex is located in the brainstem. A brain MRI helps doctors look for inflammation, lesions, or structural issues like a Chiari malformation that might be pressing on the nerves triggering your hiccups.
Can blood problems cause chronic hiccups?
Yes, chemical imbalances in your blood can affect how your nerves fire. High kidney markers like BUN and creatinine, abnormal blood sugar levels, or an overactive thyroid are all known metabolic triggers for violent hiccups.
What tests look at the chest and digestive system for hiccup causes?
Doctors may use an upper GI endoscopy to check your esophagus and stomach for acid reflux, ulcers, or swallowing issues. They might also order an ECG to ensure heart conditions like pericarditis are not irritating your vagus nerve.
How do I know if my hiccups are just caused by stress?
Psychogenic hiccups caused by stress should only be considered after all physical causes have been ruled out. If your hiccups continue while you are deeply asleep, they are almost certainly caused by a physical issue rather than a psychological one.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What specific markers were checked in my blood work to rule out kidney or metabolic causes for these hiccups?
  2. 2.When we look at my Brain MRI, are we specifically examining the medulla and brainstem area for signs of inflammation or lesions?
  3. 3.Is an upper GI endoscopy necessary to see if irritation in my esophagus is triggering the reflex?
  4. 4.Can we perform an ECG to ensure there are no cardiac issues, like pericarditis, irritating my vagus nerve?
  5. 5.At what point should we involve a neurologist or gastroenterologist in my diagnostic plan?

Questions For You

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References

References (17)
  1. 1

    [Persistent hiccups after perforated cholecystitis].

    Olsen JE, Vandsemb EN, Treider MA, et al.

    Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke 2024; (144(1)) doi:10.4045/tidsskr.23.0437.

    PMID: 38258722
  2. 2

    Successful Treatment of Persistent Hiccups in an Advanced Palliative Cancer Patient With Gabapentin: A Case Report.

    Alshammary SA, Al Fraihat LAS, Farahat YH, et al.

    Cureus 2023; (15(3)):e36982 doi:10.7759/cureus.36982.

    PMID: 37139273
  3. 3

    Innovative neurovascular decompression for chronic intractable hiccups secondary to vertebral artery dolichoectasia: a novel surgical technique. Illustrative case.

    Altayyar AA, Brokinkel B, Schick U, Fistouris P

    Journal of neurosurgery. Case lessons 2025; (9(19)).

    PMID: 40354760
  4. 4

    Intractable Hiccups Associated with Chiari Type I Malformation: Case Report and Literature Review.

    Chen Z, Shang H, Zhao W, et al.

    World neurosurgery 2018; (118()):329-331 doi:10.1016/j.wneu.2018.07.065.

    PMID: 30026156
  5. 5

    Intractable hiccups as the harbinger of a diffuse pontine glioma.

    Shankar T, Pillai A, Kaeley N, Vempalli N

    BMJ case reports 2022; (15(3)) doi:10.1136/bcr-2021-247830.

    PMID: 35292545
  6. 6

    Hiccups: An Atypical Manifestation of Miliary Tuberculosis and Myocardial Ischemia.

    Ramrattan A, Aguilar C

    Cureus 2024; (16(2)):e53595 doi:10.7759/cureus.53595.

    PMID: 38318278
  7. 7

    A Case of Bronchopneumonia Presenting With Persistent Hiccups Successfully Treated With Clonazepam and a Traditional Kampo Medicine.

    Yoshida N, Tanaka T, Suzuki Y, et al.

    Cureus 2024; (16(12)):e75237 doi:10.7759/cureus.75237.

    PMID: 39759671
  8. 8

    Case Report: Intractable hiccups induced by gallbladder necrosis after laparoscopic distal D2 radical gastrectomy: two cases report.

    Zhao Z, Lin J

    Frontiers in surgery 2026; (13()):1744253 doi:10.3389/fsurg.2026.1744253.

    PMID: 41782912
  9. 9

    Rapid Relief of Intractable Hiccups Through Bedside Diagnosis of Supragastric Belching: A Case Report.

    Ueda T

    Clinical case reports 2025; (13(8)):e70786 doi:10.1002/ccr3.70786.

    PMID: 40771553
  10. 10

    Poetic Justice: A Case of Resolved Intractable Hiccups Following POEM for Achalasia.

    Christian K, Wellington J, Kim R, et al.

    ACG case reports journal 2019; (6(4)):e00001 doi:10.14309/crj.0000000000000001.

    PMID: 31616724
  11. 11

    A case report of Vagus nerve stimulation for intractable hiccups.

    Tariq K, Das JM, Monaghan S, et al.

    International journal of surgery case reports 2021; (78()):219-222 doi:10.1016/j.ijscr.2020.12.023.

    PMID: 33360634
  12. 12

    Area postrema syndrome: Intractable hiccups and vomiting as a result of neuromyelitis Optica Spectrum disorder.

    Prabhu K, Woodman M

    JRSM open 2023; (14(4)):20542704231159601 doi:10.1177/20542704231159601.

    PMID: 37051258
  13. 13

    Prolonged hiccups induced by renal infarction: a case report.

    Kato A, Sato N, Hirose Y, et al.

    Journal of medical case reports 2024; (18(1)):34 doi:10.1186/s13256-024-04347-z.

    PMID: 38281007
  14. 14

    Intractable Hiccups in a Patient With End-Stage Renal Disease: A Five-Month Ordeal Resolved Through Hemodialysis.

    Minoretti P

    Cureus 2024; (16(6)):e61725 doi:10.7759/cureus.61725.

    PMID: 38975439
  15. 15

    Hiccups as a Rare Presentation of Thyrotoxicosis Triaged by an Epidural Steroid Injection.

    Al-Radideh O, Farouji I, DaCosta T, et al.

    Cureus 2021; (13(7)):e16438 doi:10.7759/cureus.16438.

    PMID: 34422470
  16. 16

    Intractable hiccups as a rare gastrointestinal manifestation in severe endocrine and metabolic crisis: case report and review of the literature.

    Li A, Jiang X, Zhong M, et al.

    Therapeutic advances in endocrinology and metabolism 2020; (11()):2042018820934307 doi:10.1177/2042018820934307.

    PMID: 32612802
  17. 17

    Psychogenic hiccups in an older adult: A case report and literature review.

    Al-Mahrouqi T, Al-Sabahi F, Al-Harrasi A, et al.

    Journal of Taibah University Medical Sciences 2023; (18(3)):560-565 doi:10.1016/j.jtumed.2022.10.017.

    PMID: 36818165

This page explains the diagnostic workup for chronic hiccups for educational purposes only. Always consult your healthcare provider to determine which medical tests are appropriate for investigating your specific symptoms.

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