A 25-year-old woman with 7 years of intractable hiccups treated with OMT – A case report

Abstract

Background: Persistent and intractable hiccups are poorly understood and reduce the quality of life of afflicted patients. Hiccups lasting longer than 48 hours are defined as “persistent,” and those lasting longer than 30 days as “intractable.” Both persistent and intractable hiccups are rare diseases included in the National Organization for Rare Disorders (NORD) registry, with cases of intractable hiccups being extremely rare. There are limited effective treatment options currently available for both persistent and intractable hiccups.

Clinical features: Reported here is the case of a 25-year-old female patient with a 7-year history of intractable hiccups that were successfully treated with osteopathic manipulative treatment (OMT). Her hiccups began in 2015, typically occurring in couplets, with upwards of 50 hiccups per day. In 2016, she was treated by her primary care physician for H. pylori, with no improvement. Referred to a gastroenterologist, she underwent an endoscopy that showed normal findings, and she was subsequently referred to a neurologist. A CT scan of the brain was performed and showed normal findings, prompting the neurologist to suggest muscle relaxants (which were refused at the time) and various breathing and relaxation techniques, including talk therapy. With the continued failure of these treatments, the patient attempted acupuncture without benefit. In early 2022, the patient decided to try the muscle relaxant baclofen and found no benefit after two months of treatment.

Intervention and outcomes: In August 2022, osteopathic manipulative treatment (OMT) was administered over five sessions. After the third session, the patient noticed a complete absence of her typical hiccups but began experiencing frequent “micro” hiccups that produced little-to-no sound. After the fourth treatment and continuing past the fifth treatment, the patient has had a near complete cessation of her hiccups, about 1–2 “micro” hiccups per week. Follow up with the patient on May 1, 2023, confirmed the continued resolution of her intractable hiccups.

Conclusion: In a 25-year-old female patient without prior or concurrent medical conditions, OMT techniques successfully treated intractable hiccups of a 7-year duration. This case supports a potential role for OMT in the care of intractable hiccups.