Intractable hiccups is a rare medical condition defined as daily hiccups continuing for more than 30 days and is recognized by the National Organization for Rare Disorders (NORD) and NIH Genetic and Rare Diseases (GARD) Information Center. Hiccups are spasmodic contractions of the respiratory muscles, triggered by activation of the hiccup reflex arc. Intractable hiccups can occur if this arc is chronically or aberrantly activated. The hiccup reflex arc has three components: (1) afferent pathways involving the phrenic, sympathetic, and vagal nerves; (2) central processing centers within the central nervous system; and (3) efferent fibers, including the phrenic nerve, vagal branches, and intercostal nerves. Previously published case reports have reported robust improvements to intractable hiccup disease severity after osteopathic manipulative treatment (OMT) for related areas of somatic dysfunction, with one achieving complete remission. However, no structured studies have evaluated this approach to date.
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