By Uri Bram

Hiccups are a weirdly distressing physical experience. In their normal version, they are benign and, given enough time and patience on the part of the sufferer, end by themselves. Yet there is something oddly unbearable about that brief eternity when you’ve just hiccuped and are waiting, powerlessly, for the next one to strike.

The search for a cure has, naturally enough in the age of the internet, resulted in a multitude of Reddit threads. Many claim a 100 percent, never-fails guarantee: putting a cold knife on the back of your tongue, saying pineapple, closing your eyes and gently pressing on your eyeballs, drinking water while holding down an ear. Specifically, your left ear.

Spoiler: None of these is a 100 percent, never-fails, guaranteed cure. As common and discomforting as experiencing hiccups is, remarkably little medical research has been done into the phenomenon—and even less into how to end a bout.

We might not know why we hiccup, but we have a rough sense of how hiccups happen. They involve a quick spasm of the diaphragm. The spasm causes both a sudden inhalation of air and the sudden closing of the glottis, which is the space between your vocal cords, causing the trademark “hic.” An unfortunate loop between the diaphragm itself, the phrenic nerve that controls it, and the vagus nerve—a long, wandering nerve that connects the brain to the chest, diaphragm, and other parts of the body—cause the diaphragm spasms to repeat. And repeat. And repeat.

For a long time, that was approximately humanity’s collective knowledge on the subject. Until the arrival of Ali Seifi.

Seifi is a sprightly, smiling neurointensivist at the University of Texas at San Antonio. He is also an inventor, an entrepreneur, and probably the world’s most cited hiccup expert. He is a font of excellent hiccup facts: “They can have different frequencies, but 10 times per minute is most common.” And also: “I don’t know how God created that, but most of the time they’re equally spaced.”

As a specialist in brain injuries, Seifi had often encountered patients who were suffering from post-surgery hiccups, a common pathology. But he was inspired to investigate the condition more deeply at the prompting of a stroke patient, who exasperatedly asked him, “You do heart transplants, but nothing for hiccups?”

Doctors often describe pressure in terms of centimeters of water pressure, although water needn’t be involved. Seifi found the exact threshold of pressure in the diagram required to stop a hiccup fit, which helped him understand existing remedies and work to develop a new one.

“All of the current home remedies have science behind them,” Seifi says, though perhaps not the one that involves saying pineapple. “All of them are valid! They came to the community just by trial and error.”

Seifi believes that each of the remedies ultimately works by generating the required pressure in the diaphragm—at least, sometimes. “They just don’t reach the threshold where they can stop that cycle all the time, so it’s hit-and-miss.” In 2015, Seifi set to work designing a physical tool to help with hiccups more reliably than the home remedies. He wanted to make something that could consistently generate 100 centimeters of water pressure in the diaphragm, which he deemed the effective threshold to stop hiccups in adults.

His solution was based on what physicists call Bernoulli’s Principle. “Imagine you have a water hose and you open the faucet,” Seifi says. “If you put half your thumb in front of the hose, the flow stays the same, but by changing the diameter the speed of the fluid changes; it ejects more.”

Seifi designed a special kind of straw that uses this principle in reverse. The bottom of the straw has a very small pinhole, while the drinking end has a fairly large one. To get any water through the straw, the user has to exert an unusually large amount of suction, which means generating pressure in the diaphragm. Seifi was able to calculate the required dimensions for the pinhole at the bottom, the opening at the top, and the length of the straw, such that getting water into the mouth required exerting exactly 100 centimeters of water pressure.

Seifi named his creation the HiccAway, and sold his first unit in 2020, priced at $13.42. He launched a Kickstarter campaign that raised $60,649, and co-authored a research letter published in June 2021.

Seifi didn’t stop there. In January 2022, he appeared on Shark Tank. The pitch was a success; Mark Cuban declared his unshaking belief that, in the future, everybody’s medicine cabinet would have one, and put $250,000 into the company. So far, that seems to be a sound investment. The HiccAway has now grossed more than $1 million.

Yet Seifi’s straw is not the only hiccup cure. There is another reliable method, also backed by sound science, but it does not cost $13.42. In fact, it is as free as the air you breathe.

Luc Morris is a surgeon at the Memorial Sloan Kettering Cancer Center, specializing in tumors of the head and neck. Almost 20 years ago, when he was a medical student at NYU, he wrote a letter to the editor of a specialist medical journal in which he laid out a potential treatment for “idiopathic persistent singultus,” a.k.a. the hiccups. The name he gave to the new technique was “supra-supramaximal inspiration.”

SSMI, as the medical profession’s predilection for abbreviations has it, boils down to a simple breathing exercise. First, exhale completely, then inhale a deep breath. Wait 10 seconds, then—without exhaling—inhale a little more. Wait another five seconds, then top up the breath again. Finally, exhale. Generally, you will find that your singultus is gone.

With collaborators, Morris went on to conduct a study of 19 patients, 12 male and seven female, from the ages of 10 to 51, who “presented with hiccups ranging in duration from 20 min to 8h.” As they reported, in a second letter to the editor, thanks to the SSMI technique, “an immediate and permanent termination to hiccups was achieved in 16 of the 19 patients (84%). Three patients were unable to tolerate the inspired volumes or the duration of breath holding.”

In other words, all of the people who were able to perform SSMI found that it stopped their hiccups. To this day, those two letters represent more or less the sum of medical research on SSMI. Hardly an exhaustive survey.

“We have a biologically plausible explanation about what it does to the diaphragm,” Morris told me, “but that’s based on pure speculation.” And yet, the SSMI technique is just a more sophisticated take on the old folk remedy that poses that the cure for hiccups is simply to hold your breath.

I purchased a HiccAway. As medical equipment goes, it was very reasonably priced. I can certainly see the appeal of a device that “enforces” the right behavior from the patient, rather than requiring her to follow some steps. Seifi mentioned to me that many happy customers are parents of young children; babies and infants commonly suffer from hiccups.

It’s hard to suppress the feeling that the crucial difference between SSMI and HiccAway is that only one of them can be monetized. I don’t at all think Seifi is motivated primarily by profit; he seems rightly proud to help people avoid a major minor nuisance. And he worked exceptionally hard for years to make the HiccAway straw a success.

But with that same motivation, could someone have done the same for the breathing technique? Maybe, for all the challenges of building a successful company, publicizing valuable but free information is even harder.