Electroacupuncture stimulation at auricular vagus nerve points for intractable hiccups: a case series

Intractable hiccups refer to persistent episodes lasting over 48 h that are unresponsive to conventional pharmacotherapy.1 This condition can severely impact daily life, interfering with basic activities such as communication, eating, and sleep.2 While standard drug therapies are often limited by side effects, acupuncture represents an alternative. However, few studies have focused on electroacupuncture targeting the auricular vagus nerve for this condition. We report three cases where this approach yielded significant improvement after pharmacological failure and discuss its potential mechanisms. We reported three male patients (aged 25, 67, and 71) with medication-intractable hiccups of varying etiologies: case 1 from improper diet, case 2 following chemotherapy for gallbladder cancer, and case 3 with a history of cerebral infarction and long-term aspirin use. All patients presented with severe, persistent hiccups (duration: 7–473 days; frequency: 24 h/day), which significantly impaired daily activities and sleep. Baseline subjective assessment scale (SAS) scores indicated moderate-to-severe hiccups (scores 6–8).3 They received electroacupuncture stimulation targeting the auricular branch of the vagus nerve at bilateral acupoints CO2 (Esophagus) and CO4 (Stomach), as shown in Figure 1. The treatment involved 30-min sessions with a 2 Hz continuous wave. As summarized in Table 1, the outcomes were excellent. Patients 1 and 2 achieved complete cessation of hiccups after only 1–2 sessions, with SAS scores dropping to 0. Patient 3, with the most protracted history, showed significant improvement after 9 sessions administered three times weekly; his hiccup frequency substantially decreased, and the SAS score reduced to 3, indicating only mild symptoms. Notably, no adverse events occurred, and the therapeutic benefits were sustained during a 3-month follow-up period.