Post CVA hiccups

Q: 72 years old male with recent stroke developed intractable hiccups lasting more than 48 hours. What is the drug of choice for post-CVA hiccups?

Answer: Gabapentin

Although there are many non-pharmacological, pharmacological, and surgical interventions for intractable and prolonged cough but in patients who develop hiccups after stroke, gabapentin is considered to be the first line of drugs. It can also be combine with other known agents such as proton pump inhibitor (PPI), baclofen, or metoclopramide.

In refractory cases, more aggressive interventions may be needed such as vagus nerve stimulator, implantable breathing pacemaker, a trial of positive pressure ventilation, phrenic nerve blocking, cervical epidural blocks at C3 to C5 (levels supplying the phrenic nerve).

References:

Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther 2015; 42:1037.

Thompson DF, Brooks KG. Gabapentin therapy of hiccups. Ann Pharmacother 2013; 47:897.

Grewal SS, Adams AC, Van Gompel JJ. Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature. Int J Neurosci 2018; 128:1114.

Byun SH, Jeon YH. Treatment of idiopathic persistent hiccups with positive pressure ventilation -a case report-. Korean J Pain 2012; 25:105.

Kim JE, Lee MK, Lee DK, et al. Continuous cervical epidural block: Treatment for intractable hiccups. Medicine (Baltimore) 2018; 97:e9444.