As hard as it can be to admit, you can have a stroke. Your loved one can have a stroke. Statistically, someone in the United States has a stroke every 40 seconds; every 3 minutes and 14 seconds, someone dies of a stroke. It is not a concern to ruminate on, per se, but one to be mindful of. For example, you might avoid habits that can increase the risk, such as being sedentary, smoking, ignoring health concerns and drinking alcohol. Knowing the clear signs of a stroke — illustrated by the BE FAST acronym — is smart, too. BE FAST stands for (problems with) balance, eyesight, facial drooping, arm weakness, speech and time or terrible headache. However, there is also a super random, surprising sign of a stroke that many people do not know, according to vascular surgeons: hiccups. Ahead, experts explain how hiccups can be a sign of a stroke, other commonly missed signs and when to see the doctor about this seemingly harmless symptom.
How Hiccups Can Signal a Stroke
To understand why hiccups can be a sign of a stroke, it is important to understand exactly what hiccups are — particularly, how they are connected to the brain.
“Hiccups are caused by involuntary contractions of the diaphragm, coordinated by a reflex arc involving the brainstem, particularly the medulla,” said Dr. Christopher Yi, a board-certified vascular surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “In rare cases, a stroke affecting this region — most classically a lateral medullary (Wallenburg) stroke — can disrupt that reflex and trigger persistent hiccups.”
Usually, hiccups are not so concerning. You might get them after eating too fast, moving too quickly after eating or drinking a carbonated beverage. But if a stroke in the brainstem is causing the hiccups, they need to be taken more seriously. “In rare cases, hiccups can be linked to a stroke — specifically a stroke affecting the brainstem,” said Dr. Adeel Popalzai, a vascular neurologist and stroke program director at Pomona Valley Hospital Medical Center. “The brainstem is involved in the hiccup reflex pathway. When a stroke disrupts this area, it can cause persistent, uncontrollable hiccups that do not respond to usual remedies.”
Yi affirmed that persistent hiccups have been documented in posterior circulation strokes, which affect the back of the brain. They also do not always cause one-sided weakness (a classic symptom of a stroke) and rather present with more subtle symptoms. This makes hiccups an early and arguably clearer clue, especially when present with other neurologic abnormalities.
That last piece is vital because otherwise, a lot of us would get unnecessarily nervous when we get the hiccups, right?
“It is important to remember that hiccups alone are almost never a stroke, but persistent hiccups with other symptoms can be a warning sign,” Popalzai stressed.
Strokes are better managed the earlier you get medical attention.
Other Commonly Missed Signs of a Stroke
Hiccups are not the only symptom of a stroke that often goes ignored, especially with posterior circulation strokes. “Many people expect a stroke to look dramatic, but some of the most dangerous strokes — especially those in the back of the brain — can present with subtle or misleading symptoms,” Popalzai warned.
The vascular surgeons listed the following symptoms:
- Sudden dizziness, vertigo or a spinning sensation
- Trouble walking, or loss of balance or coordination, which can look like clumsiness, intoxication, veering to one side, difficulty standing or coordinating movements and generalized weakness
- Visual disturbances, such as double vision, trouble focusing or loss of part of the visual field
- Difficulty swallowing
- A sudden, severe headache (particularly in hemorrhagic strokes) — it can signal a brain bleed
- Nausea and vomiting, especially when combined with dizziness or imbalance
- Sudden confusion or trouble understanding, which can present as difficulty processing information or following a conversation, and may appear as disorientation or memory trouble
“These symptoms are often missed because they do not fit the ‘classic’ stroke picture, but they are just as important,” Popalzai said.
When to Go to the Doctor About Hiccups or Other Stroke Symptoms
Since hiccups are usually no big deal (well, other than being super annoying), how do you know when you have got a normal bout of the hiccups versus a stroke? According to Yi, consider medical evaluation “when they persist for more than 48 hours, become severe or disruptive or occur in conjunction with neurologic symptoms.” Examples of the latter are the same as above: dizziness, vertigo, difficulty walking, imbalance, double vision, slurred speech and trouble swallowing.
Popalzai agreed it is best to focus on the context and associated symptoms. He encouraged calling 911 immediately if you or a loved one experiences those signs. Additionally, having a stroke risk factor, such as high blood pressure, diabetes, heart disease, smoking or a prior stroke, is also a reason to call the doctor ASAP. “When symptoms are sudden and unusual, it is always better to err on the side of caution and seek medical attention,” he added.
Yi emphasized the timely nature. “When hiccups present suddenly with any of these neurologic findings, the situation should be treated as a potential stroke emergency, and immediate medical attention is warranted, as timely intervention can significantly improve outcomes,” he said.
The bottom line is that while most hiccups are harmless, they can signal a stroke when accompanied by other brain-related symptoms. Do not let an unexpected sign of a stroke convince you that a stroke is not at play. Take it all seriously. “Acting fast can save brain function, independence and life,” Popalzai said.
