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The central elements and efferent limbs of the hiccup reflex have been better characterised than the afferent limb. The hiccup is an involuntary medullary reflex influenced by, but independent of, the respiratory centre of the medulla. In a meticulous investigation, Davis demonstrated that hiccup frequency could be modulated or completely suppressed by inhalation of CO2 (the physiology behind the remedies of rebreathing into a paper bag and breath holding).6 Furthermore, the whole array of inspiratory muscles are activated on the efferent side of the reflex: the phrenic nerves to the diaphragm, the external intercostal nerves (T1 T11) to the intercostal muscles, and the scalenus anticus nerve to the scalene muscles which elevate the clavicles.4.
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