Edie and Arthur Hessel were married on Halloween morning nearly 45 years ago. Of all their memories of that special day, one stands out: the unrelenting attack of hiccups that struck the groom during their wedding breakfast. His hiccuping went on for hours, and finally ended late that afternoon when their car broke down on the way to their honeymoon destination.

“We stopped at a gas station and by the time we figured out what was wrong with the car, there were no more hiccups,” said Edie Hessel, 73, a retired school nurse who lives in Washington D.C. with her husband, 78, a retired attorney. “I think the breakdown was a distraction that stopped them. I think they were caused by nerves, although he would never admit it. I’m just glad they didn’t start under the chuppah.”

All of us get them. For most, hiccups are nothing more than a temporary annoyance. Some people, however, can get them for days at a time, which disrupts their daily lives and can drive them to seek help from the nearest emergency room. Pope Pius XII suffered from recurrent bouts of hiccups, and, more recently, Brazilian President Jair Bolsonaro left the hospital after struggling with nonstop hiccups for 10 days.

“I’ve seen people with days of this, and they are absolutely miserable,” says Louis Korman, a semiretired D.C.-area gastroenterologist. “Just imagine: You can’t sleep. You can’t eat. You can’t work.”

Hiccups are involuntary contractions of the diaphragm, the muscle between the chest and abdomen. Each contraction is followed by a sudden closure of the vocal cords, which produces the characteristic “hic” sound.

Hiccups can result from many causes, among them eating a large meal, spicy foods, eating too quickly, drinking alcoholic or carbonated beverages, stress or sudden excitement. They also can be a side effect of anesthesia – some surgery patients wake up with hiccups in the recovery room – stroke or other brain injuries, or from cancer chemotherapy.

“I’ve seen people who get one hour of chemotherapy, followed by days of hiccups,” says Ali Seifi, associate professor of neurosurgery and director of neuro critical care at the University of Texas Health Science Center San Antonio.

“This is the impact of chemotherapy on the brain center,” Seifi says. “I treated one brain cancer patient who said his hiccups were bothering him more than his cancer. Every couple of seconds he would have this spasm in his chest, like an electric pulse. It’s very upsetting and annoying for them.”

Less commonly, hiccups – when accompanied by nausea and vomiting – can signal a potentially serious condition, neuromyelitis optica. The nervous system disorder affects the optic nerves and spinal cord, often leading to blindness and paralysis. It can be detected by a simple blood test that identifies specific antibodies, a biomarker of the disease. Steroids can stop the hiccups, while early treatment with drugs can help prevent blindness and paralysis, the most serious consequences.

“People with this usually have been in otherwise perfect health,” says Mayo Clinic neurologist Brian Weinshenker, who studies the disease. “It usually just comes out of the blue. Some people will have just hiccups. Some will have just vomiting. Many will have both. If the symptoms are persistent and don’t respond to standard treatment, consider this [as a possible diagnosis]. I think it’s a relatively rare condition. But it’s an important one that – if identified – will allow you to intervene early to prevent blindness and paralysis.”

For the majority of ordinary cases, plenty of home remedies are available. These include, among other things, holding your breath (inhale a large gulp of air and hold it for about 10 to 20 seconds, then breathe out slowly and repeat); measured breathing (breathe in for a count of five and out for a count of five); breathe into a paper (never plastic) bag (place a paper lunch bag over your mouth and nose, slowly breathe in and out, deflating and inflating the bag); hug your knees (bring your knees to your chest and hold them there for two minutes); compress your chest (lean or bend forward to compress your chest, putting pressure on your diaphragm); or use the Valsalva maneuver (try to exhale while pinching your nose and keeping your mouth closed).

Some people recommend swallowing water while holding the nose closed, drinking ice water, drinking water through a cloth or paper towel, or drinking from the opposite side of the glass. Other ideas include eating peanut butter, or sucking on an ice cube or a lemon.

Edie Hessel swears by this one, although it failed to stop her husband’s wedding day hiccups. “My tried-and-true, surefire method is to stick a knife in a glass of water, sharp end down, with the handle up against forehead,” she explains. “Tilt your head back and take a drink of water. It works for me every time, even though it didn’t work for him.”

Korman, the gastroenterologist, says his wife cures her hiccups with a similar method and says it always works.

“She puts a spoon in a glass of water with the handle next to her temple, and then drinks,” he says. “It works. What you are doing is trying to disrupt the neural pathway. It’s like squeezing your eyes real tight when you feel a sneeze coming on. You’re changing the circuit. It’s like hitting control, alt, delete and rebooting the distraction.”

When hiccups are intractable, doctors may treat them with drugs. Chlorpromazine, also known as Thorazine, is the only drug approved by the Food and Drug Administration to treat hiccups, although some clinicians also may use anti-seizure medications to try to control them.

“Typically, we have to make sure there isn’t some irritation of the diaphragm, so often the patient will have a [CT] scan to see if there is something there, such as an abscess or a tumor,” Korman says. “Once hiccups are diagnosed as idiopathic [no identified medical cause], we just give them a prescription and they take it when the hiccups start.”

Seifi has invented a device called HiccAway that he says is effective in stopping many cases of persistent hiccups. It’s a rigid drinking tube with an inlet valve that requires forceful suction to draw water from a cup into the mouth. The suction and swallow simultaneously stimulate two nerves, the phrenic and vagus nerves, prompting the diaphragm to contract and the epiglottis – a flap that covers the windpipe during swallowing – to close. The combination disrupts the hiccups’ cycle, he says.

A small study of the device found it stopped 92 percent of cases, and volunteers rated it more effective than home remedies.

“There are millions of people searching for ways to get rid of hiccups,” Seifi says. “This is a simple device, like a toothbrush, not a medical device [he says it doesn’t need FDA approval], specifically for home users.”

Meanwhile, Arthur Hessel still gets hiccups from time to time, but nothing as dramatic as his wedding day siege.

“One night he went to bed with them, and I decided to scare him out of them,” Edie Hessel says. “It worked, but I’ll never try that again.”