Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature

Introduction: Hiccups are common and typically resolve spontaneously. However, in rare cases, they can continue for days, weeks or even years, causing significant morbidity and discomfort in patients. In the setting of intractable hiccups, vagal nerve stimulation has been reported in two cases. Objectives: This is a case report and review of the literature regarding the use of vagal nerve stimulators for intractable hiccups. Specifically, this report highlights a case where this therapy was not effective, as two prior case reports have reported positive results. Case report: A 52-year-old man presented with multiple years of intractable hiccups. A workup revealed no identifiable aetiology, and he had failed multiple medical therapies. A phrenic nerve block was attempted, which was not beneficial. Vagal maneuvers, specifically the induction of emesis, did consistently provide transient relief of his symptoms, and, therefore, the decision was made to proceed with a trial of vagal nerve stimulation after review of the literature supported the therapy. Despite 8 months with multiple stimulation parameters, the patient did not have any significant benefit from vagal nerve stimulation. Conclusions: Intractable idiopathic hiccups continue to present a significant challenge for physicians and patients. While vagal nerve stimulation is a potentially beneficial therapy, it is not effective in all patients with central idiopathic intractable hiccups.