Hiccups

Hiccups are repeated, involuntary contractions of the diaphragm and the other muscles used to breathe in, each cut short by the sudden closing of the vocal cords. The Cochrane review on the subject calls an episode persistent when it lasts more than 48 hours and intractable when it lasts more than a month, and lists more than 100 causes, among them lesions of the brain, irritation of the diaphragm or the vagus nerve, drugs, metabolic disturbance and surgery. It cites reports that 3.9% to 4.5% of people with advanced cancer have severe persistent or intractable hiccups, and Wang and colleagues call them a frequent complication of stroke. The trials of acupuncture for them come almost entirely from China and almost all set acupuncture against a drug or against another form of acupuncture. The Cochrane review found no trial that compared it with a placebo.

The Cochrane review

Cochrane’s 2013 review by Eric Moretto and colleagues set out to assess every drug and non-drug treatment for persistent and intractable hiccups in adults. It searched to March 2012 and accepted randomised or controlled clinical trials with at least ten participants. Four studies, with 305 people, qualified, and all four tested acupuncture; no drug trial met the criteria. The authors rated all four at high risk of bias: none appeared to be blinded, none described how participants were randomised, and none reported side effects. The trials differed too much to pool.

None of the four compared acupuncture with a placebo. Bao 2003, in 85 people with hiccups for more than three days, compared the same body, scalp and ear points with the needles left in for 30 minutes against longer retention; 40 of 45 were cured in the longer-retention group and 26 of 40 in the other. Han 2006 compared acupuncture plus an injection of toad extract with acupuncture plus an injection of vitamin B6, in 40 people a group. Jiang 2002, in 60 people, compared two sets of points and found more cured after one session in one group but no difference in the total cured by the end. Wang 2011, in 80 people whose hiccups had not responded to drugs, added a fourth point to three, and reported a total effective rate of 97.5% against 85%. The total effective rate, used in most of the trials on this page, counts everyone a trial judged cured or improved.

The authors concluded that the evidence was insufficient to guide treatment with either drugs or non-drug measures, and called for placebo-controlled trials across several centres and countries, since the symptom is rare. Cochrane declared the review stable in 2016 and again in October 2019, after a restricted search found nothing likely to change its conclusions, and said it would be reassessed for updating in five years.

Later reviews

Later reviews narrowed the question to one cause, mainly cancer or stroke, and searched the Chinese databases the Cochrane authors could not fully reach.

Cancer

Choi, Lee and Ernst searched 13 databases without language limits to July 2011. Most of their trials favoured acupuncture over conventional treatment, and pooled across 162 people its response rate was higher than that of intramuscular injections (risk ratio 1.87, 95% CI 1.26 to 2.78). They called this very limited evidence and asked for rigorous trials. Guo and colleagues in Guangzhou updated the question to July 2023. All nine of their trials came from China, and every control group had a drug or conventional care. Their abstract rates all nine at high risk of bias, mainly for lack of blinding and for how participants were randomised. Pooled, acupuncture’s effective rate was higher than drug treatment’s (risk ratio 1.83, 95% CI 1.53 to 2.20). They add that sham acupuncture was not used enough to separate out the placebo effect, and concluded that no conclusive evidence supports acupuncture for cancer-related hiccups. ST36 (Zusanli), below the knee, and PC06 (Neiguan), on the inner forearm, each appeared in seven of the nine trials.

The most detailed account of what was needled comes from a 2010 case series at the Clinical Research Center of the US National Institutes of Health, which had no comparison group. Ge and colleagues treated 16 men with cancer and persistent hiccups, giving one to three 30-minute sessions over one to seven days at BL17 (Geshu), GV14 (Dazhui), CV12 (Zhongwan), PC06, ST36, BL20 (Pishu), BL21 (Weishu) and LV14 (Qimen). Thirteen had complete remission, and none reported an adverse effect.

After stroke

Yue and colleagues searched English and Chinese databases to June 2015 and found five trials. Added to medical treatment, acupuncture stopped hiccups within a set period more often than medical treatment alone (risk ratio 1.59, 95% CI 1.16 to 2.19); used instead of it, the difference was not significant (1.40, 0.79 to 2.47), and those trials disagreed widely. No trial reported on safety, and the authors could not reach a definitive conclusion. Wang and colleagues pooled 16 of their 18 trials, with 1,206 people, and found a higher effective rate with acupuncture (risk ratio 1.27, 95% CI 1.21 to 1.33). They cite the lack of blinding and allocation concealment and possible publication bias, and ask for better trials.

By 2025 the post-stroke question had been reviewed often enough that Liu and colleagues reviewed the reviews. They judged the methods of nine of the ten as very low quality and the tenth as low, rated the certainty of the findings moderate to very low, and found moderate to high overlap in the trials the reviews drew on. Safety data were too thin for firm conclusions. Tan and colleagues ranked treatments built around acupoint injection, in which a drug or other solution is injected at an acupuncture point. Conventional acupuncture combined with ear acupuncture ranked first and acupoint injection added to Western drugs second, though the authors rated the evidence for many of the treatments as low. Stroke recovery covers acupuncture after stroke more broadly.

Intractable hiccups of any cause

Zhai and colleagues took trials published between January 2015 and January 2025. All 41 were run in China and published in Chinese, which the authors name as a source of language and regional bias. The trials tested 15 acupuncture-related treatments, among them needling, electroacupuncture, acupoint injection, ear acupressure and combinations with herbal medicine or drugs. Manual acupuncture with acupoint injection ranked highest for total effective rate and quality of life, and electroacupuncture with drugs for reducing hiccup symptoms. Sham acupuncture was an eligible comparison, but none of the review’s head-to-head comparisons set an acupuncture treatment against it. Practitioners could not be blinded, so every trial was at high risk of performance bias, and only two reported blinding the people who assessed the results. Seventeen trials reported adverse events, and none reported a serious one.

A trial after liver surgery

A 2018 trial at the First Affiliated Hospital of Heilongjiang University of Chinese Medicine randomised 39 people with intractable hiccups after surgery for liver tumours. Twenty had electroacupuncture at the cervical Jiaji points beside the third to fifth neck vertebrae, and 19 had metoclopramide with chlorpromazine for three days. The authors report a total effective rate of 95.0% against 47.4%, and an onset of effect after about 15 hours against about 31.

What guidelines say

The Scottish Palliative Care Guidelines, written for health professionals in Scotland caring for adults with a life-limiting illness, have a section on hiccups that the guideline schedule lists as partially updated in 2019 and current. It states that most studies were uncontrolled and underpowered, so any recommendation is made cautiously, and that treatment of persistent and intractable hiccups rests on the preferences of patients and clinicians until randomised trials give more evidence. Under non-drug management it says acupuncture may be effective. Its drug options include peppermint water, simeticone antacids, metoclopramide or domperidone, dexamethasone and, on specialist advice, haloperidol, baclofen, levomepromazine and nifedipine. Clinical guidelines sets out other bodies’ positions condition by condition.

What the reviews could not settle

The Cochrane review found no placebo-controlled trial, Guo and colleagues say sham acupuncture was not used enough, and none of Zhai’s head-to-head comparisons was against sham. The reviews therefore cannot say how much of the reported effect comes from needling at particular points and how much from the attention, expectation and time that come with treatment. Sham acupuncture explains the designs that try to separate them. The later reviews report effective rates against drugs whose own evidence the Cochrane review found too thin to assess, in trials published almost entirely in Chinese, which Zhai and colleagues say reflect Chinese practice and may not carry over to other settings. The Scottish guideline notes that hiccups often stop on their own, which an uncontrolled case series cannot account for. The reviews that pooled a single cause, cancer or stroke, cannot say whether their findings hold for the others. Every review ends by asking for better-designed trials, and the Cochrane authors for trials across several countries.

AcuiQ’s hiccup and persistent hiccups pages list the protocols individual studies prescribed, each with its citation.