Are hiccups connected to migraines?

This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making health decisions.

Hiccups are a universal human experience; nearly everyone experiences hiccups many times throughout life. Migraines, on the other hand, are intense headaches often accompanied by nausea and sensitivity to light. Migraines are not just bad headaches; they rank among the top three causes of neurological disability worldwide. At first glance, these two issues seem unrelated. But recent cases and research have prompted doctors to ask whether a bout of hiccups could be linked to a migraine episode.

Are hiccups connected to migraines?

Hiccups are not a common feature of migraines, but rare cases hint at a connection. In a rare type of migraine that involves the brainstem, hiccups have been observed as an unusual symptom in some patients. However, for most people, migraines and hiccups remain separate problems.

Scientists first began documenting this link in recent years. In 2015, a case series reported hiccups as a migraine aura in several patients. In these cases, the hiccup episodes occurred right before or at the start of the headache. Such reports are exceedingly uncommon, but they show it is possible for a migraine attack to trigger hiccups in rare instances.

Can hiccups be a migraine aura?

Yes, though it’s exceptionally rare. In isolated cases, hiccups have been documented as a migraine aura symptom. (A migraine aura is a short-lived neurological disturbance; often visual flashes or tingling; that precedes the headache in roughly 25% of migraine patients.) A few individuals have experienced bouts of hiccups right before their migraine pain begins, effectively making hiccups their aura.

Typical migraine auras involve symptoms like visual zigzag lines, numbness, or difficulty speaking; not hiccups. That’s why reports of hiccup auras stand out. Neurologists suspect that when this occurs, the migraine activates unusual neural circuits in the brainstem that also trigger the hiccup reflex. Migraine with brainstem aura (formerly called basilar migraine) often includes odd aura symptoms such as vertigo, double vision, or slurred speech. In a few of those rare cases, hiccups have been noted as well, indicating that the migraine’s brainstem activity may be sparking the hiccup reflex. Still, hiccup auras are so uncommon that more research is needed to understand why they happen.

How could migraines trigger hiccups?

Migraines might trigger hiccups by irritating overlapping nerve circuits in the brainstem. Hiccups result from a reflex arc involving the vagus and phrenic nerves and a center in the lower brainstem. If a migraine disturbs this "hiccup center" in the medulla oblongata, it could theoretically set off the diaphragm spasms that cause hiccups.

In other words, a migraine attack affecting the brainstem might stimulate the same pathways that trigger hiccups. The vagus nerve; which runs from the brainstem to the diaphragm and beyond; is a key player in both migraine symptoms and the hiccup reflex. (Interestingly, devices that stimulate the vagus nerve are being used to treat migraines, highlighting the vagus nerve’s role in headache biology.) If a migraine aura or pain phase involves the medulla oblongata, it may inadvertently activate the diaphragm via the vagus/phrenic nerve circuitry, resulting in hiccups. This would explain why hiccups have been observed in some brainstem-related migraines, though such cases remain exceedingly rare.

When should you worry about hiccups?

You should seek medical attention if hiccups last longer than 48 hours or occur alongside other serious symptoms. Hiccups lasting more than 48 hours (called persistent hiccups) should be medically evaluated. They can sometimes be caused by nerve irritation or central nervous system disorders, so chronic hiccups should never be ignored.

In general, short bouts of hiccups are harmless and go away on their own. But if hiccups persist for days or keep returning frequently, it’s wise to see a doctor. Hiccups that won’t stop can occasionally be the only clue to a serious condition in the brain or chest. For example, one case report showed that a patient’s intractable hiccups and vomiting were the initial manifestation of NMOSD; a rare autoimmune disease. Chronic hiccups have also been documented in people with strokes, brain tumors, or infections affecting the brainstem. In summary, if you have hiccups lasting beyond 2 days; especially if accompanied by headaches, weakness, or confusion; you should get checked by a healthcare provider to rule out an underlying cause.

Remember, this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions about your health.