What experts say to do about hiccups, nosebleeds, shivers and twitches

Hiccups, nosebleeds and the occasional twitch or shiver -- they're annoying, embarrassing, all too common and rarely serious enough to warrant a trip to the doctor.

Every now and then, they can indicate something serious, though. How can you tell the difference? Before you go to the doctor, what home remedies are safe to try? For advice we consulted several experts on staff at Baylor Regional Medical Center in Plano.


What they are: Involuntary, intermittent, spasmodic contractions of the diaphragm, followed by a sudden closure of the epiglottis (the cartilage protecting the vocal cords), which makes the hiccup sound. They have no known function, but they may occur in a fetus as early as the third trimester of pregnancy.

Types: Doctors define hiccups by how long they last. Transient hiccups last for up to 48 hours; persistent hiccups may last 48 hours to 30 days; intractable hiccups may last for more than two months.

Common causes: Anything that irritates the stomach and esophagus, including overeating or eating too quickly, carbonated beverages, sudden excitement, emotional stress, laughter, hot and spicy foods or liquids, and noxious fumes.

Rare causes: Head trauma, stroke, meningitis, electrolyte abnormalities, general anesthesia, gastric distention, acid reflux, laryngitis and pharyngitis. They also may be symptomatic of a serious condition involving the respiratory system, nervous system, metabolism or of certain tumors and cancers.

When should you call the doctor? When you have persistent or intractable hiccups, which can lead to malnutrition, weight loss, fatigue, dehydration and insomnia.

Home cures: Largely anecdotal, these cures usually involve altering your breathing patterns by inhaling and exhaling into a bag; holding your breath; drinking a glass of water; swallowing a teaspoon of sugar, peanut butter or vinegar; drinking from the opposite side of a glass; fright; and the Valsalva maneuver (closing your mouth, pinching your nose and forcibly exhaling).

Medical cures: Muscle relaxants, anticonvulsants, antispasmodics, antipsychotics, gastrointestinal stimulants, antidepressants and massage of the carotid sinus in the neck.


What they are: Loss of blood from the tissue lining the nose.

Common cause: Dryness of the nose that leads to cracking of the mucous membranes. The dryness can be caused by temperature changes or low humidity. Air conditioning and heated environments also can dry the nose.

Additional causes: Aside from direct injury, colds, blowing the nose, allergies, sinusitis, upper respiratory infection, chemical irritants or overuse of decongestant nasal sprays. People on blood thinners such as aspirin also can be more prone to nosebleeds.

Less common cause: Deviated septum. The septum is a vertical wall of cartilage and bone that separates the two sides of the nose. A deviation in the septum causes abnormal airflow through the nose.

When should you call the doctor? When you have severe blood loss, nasal obstruction, pain, a nosebleed that doesn't stop after 20 minutes or if the nosebleed occurs after an injury to the head. Repeated nosebleeds may be a symptom of high blood pressure, a bleeding disorder or a tumor of the nose.

Home cures: Elevate your head, apply cold compresses or ice across the bridge of your nose and pinch the soft portion of your nose between your thumb and finger for 10 minutes. Lean forward to avoid swallowing the blood and breathe through the mouth. After the nosebleed, use an antibiotic ointment twice a day inside the nostrils, about an inch into the nose. Use saline sprays every two or three hours for at least a week to add moisture. A vaporizer or humidifier in the room can help.

Medical cures: Cauterizing or closing the blood vessels using heat, electric current or silver nitrate sticks. Some doctors recommend oxymetazoline (such as Afrin) nasal spray or QuikClot for home use. Oxymetazoline is not advised for children younger than 6 unless a doctor recommends it; children 6 to 12 should use it only under adult supervision. You should consult a doctor before using QuikClot as well.

Twitches and shudders

What they are: Muscle twitching is caused by a minor muscle contraction or uncontrollable twitching of a muscle group served by a single motor nerve fiber; shivering is a diffuse body movement manifested by an alteration of muscle tone.

What causes them: The most common cause of eye twitching can be dry eye, which can come from staring at a computer screen all day. Twitches in the calf and fingers are common, too, and can be caused by repetitive, strenuous actions such as the kinds used in keyboarding or certain sports. Shivering is most commonly the result of the body's defense mechanism to prevent heat loss, but it also can occur if you're excited or afraid. Shivering protects your body by tightening the arteries supplying the muscles, resulting in the muscles tightening and loosening quickly to increase metabolism.

Less common causes: Shivering can result from poisonings such as from alcohol, which increases the diameter of the artery, speeding heat loss. Twitches and shivers also can be caused by diuretics (water pills), dietary deficiencies, excessive stress or anxiety, insomnia, medication, infection, multiple sclerosis, seizures, Lou Gehrig's disease (amyotrophic lateral sclerosis), toxin exposure, problems with electrolytes, thyroid gland function and blood chemistry.

When should you call the doctor? When you have long-term or persistent muscle twitches or shivering.

Home cures: Stretching, massaging and resting the muscles that are twitching. Stay warm if you're shivering.

Medical cures: For eye twitches, a shot of Botox can calm the eye muscle; for shivering, medical remedies will only help if blood tests determine a medical condition, such as low metabolism, medication or infection, as the cause.

Sources: Gastroenterologists Dr. Terilyn Scott-Winful, Dr. Rassa Shahidzadeh and Dr. Shibu Oommen; internal medicine physicians Dr. Carlyle A. Stewart, Dr. Christina Kuo, Dr. Tyler Duong and Dr. Mildred A. McAfee; and otolaryngologists Dr. Allison Wyll and Dr. Colin D. Pero. Also consulted was Medline Plus, a service of the U.S. National Library of Medicine National Institutes of Health.