for Intractable Hiccoughs
by Lester Grinspoon, M.D.
Everyone has experienced hiccoughs, but little is known about them. Ordinarily, hiccoughing is short-lived and benign and therefore of little clinical interest. But occasionally people suffer bouts of intractable hiccoughs, which become extremely uncomfortable and eventually create a health problem, making it difficult to sleep and even eat. Little is known about the treatment of this condition.
I have suffered from prolonged hiccoughs occasionally. One episode in medical school lasted almost 72 hours. I could not attend classes and could not sleep. I was treated at the Brigham & Womens Hospital (then the Peter Bent Brigham Hospital) to no avail. Eventually the hiccoughing stopped as unexpectedly as it had started. Several years later I learned from a letter in the New England Journal of Medicine that prolonged hiccoughs could be interrupted by placing a teaspoon of granular sugar on the tongue. This simple remedy worked for me usually but not always. About four years ago, during an episode when this method failed, I smoked some marijuana and found that the hiccoughs stopped immediately. Twice since then I have gotten the same relief after smoking marijuana.
Until recently I have not been sure whether this was a consequence of some property of cannabis or due simply to chance or some psychological phenomenon. I had no idea whether it would be useful to anyone else who suffered from prolonged or intractable hiccoughs. But last week I read the following report from Ian Gilson and Mary Busalacchi in the British medical journal Lancet, Volume 351, Number 9098 - Saturday 24 January 1998, SECTION: Research letters:
Marijuana for Intractable Hiccups
A patient with AIDS and a history of oesophageal candidosis underwent minor ambulatory surgery. He was on indinavir, and he received perioperative intravenous midazolam and dexamethasone. The following morning he developed persistent hiccups. Chlorpromazine controlled the hiccups only during sleep. Oral nifedipine, valproate, lansoprazole, and intravenous lidocaine had no effect. Glabellar acupuncture on day six and nine terminated the hiccups for less than an hour. Removal of a hair from the tympanic membrane on day eight and irrigation of Marcaine into the external auditory canal on day nine gave only brief relief. On day eight the patient, who had not smoked marijuana before, smoked marijuana, and his hiccups stopped. They recurred on day nine and on day ten the patient again smoked marijuana; hiccups stopped immediately and did not recur. On day 14 he was found to have fluconazole-resistant oesophageal candidosis on oesophagoscopy, and was treated with oral itraconazole solution and oral amphotericin B.
Intractable hiccups has been reported as an uncommon complication of AIDS; in the largest series, most cases were attributed to oesophageal candidosis and other oesophageal diseases.1 This patient did have oesophageal candidosis, but it was longstanding and his hiccups stopped before a change in treatment, so this is unlikely to be the cause of his hiccups. Midazolam2 and dexamethsone3 are the drugs most commonly associated with iatrogenic hiccups. The patient received both shortly before the onset of hiccups, and indinavir may have prolonged the effect of midazolam by inhibiting its metabolism. Although midazolam is contraindicated in patients on protease inhibitors, it and other proscribed drugs may be inadvertently administered if the potential for drug-drug interactions is not considered.
Anecdotal reports support the use of marijuana in AIDS-related nausea and anorexia, and dronabinol is approved for treatment of AIDS wasting. Because intractable hiccups is an uncommon condition, it is unlikely that the use of marijuana will ever be tested in a controlled clinical trial, and blinding would be difficult. Despite federal policy which forbids the use of marijuana therapeutically,4 this report should be considered for hiccups refractory to other measures.
1 Albrecht H, Stellbrink HJ. Hiccups in people with AIDS. J Acquir Immun Defic Syndr 1994; 7: 735
2 de Mendonca MJT. Midazolam-induced hiccoughs. Br Dent J 1984; 157: 49
3 Vasquez JJ. Persistent hiccup as a side effect of dexamethasone treatment. Hum Exp Toxicol 1993; 13: 32.
4 Kassirer JP. Federal foolishness and marijuana. N Engl J Med 1997; 336: 366
I was a dancer and dance teacher in Nova Scotia. In 1982 a woman fell asleep behind the wheel on the Trans-Canada highway, crossed into the opposing traffic, and hit my car head-on. Since we were traveling in opposite directions, our combined speed was over 100 miles per hour. I was near death when I entered the hospital. Since then I have spent many months in hospitals, receiving over 12 operations, including open heart surgery, two complete hip replacements on the same leg, and numerous other surgeries, leaving my body decorated with scars, some over a foot long. Although my dancing life was permanently over, I am lucky to be alive, and on most days I give great thanks.
My insides are covered with adhesions, and my digestion has not worked properly since the accident. I am constantly nauseated, and any movement, whether by traveling or simply by coughing, causes pain and nausea in my abdomen and chest. Conventional painkillers and anti-nausea drugs are of little or no help as they invariably make me sicker. For many years I have used marijuana exclusively for my medication. The uses to which I put marijuana are well documented, namely as an analgesic, as a nausea preventative and appetite stimulant, and to calm recurrent muscle spasms.
I am writing to you today because you have mentioned one of the peculiar and little-known benefits of the remarkable cannabis flowers, namely the power of marijuana to cure hiccups. Hiccups are a problem for me; not because they are sustained or recurring, but simply because they are very painful when I do have them. I cannot hiccup without aggravating my chest and internal organs. I dont know why, but I can hold my breath and do all the other things for hiccups (including the sugar treatment you mention) without avail, but if I hold my breath with marijuana smoke the hiccups go away. Smoking marijuana simply stops the hiccups. For years I have been telling this to friends when the subject of hiccups arises! I am delighted to see by your account on your website that I am not alone in this experience.
I would like to close with a simple note of thanks to you, and to everyone who puts their freedom on the line to help bring this healing herb into the hands of a people so needful.
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