Of the many benign issues that plague the human body, hiccups are probably one of the strangest. They seem to strike at the most inconvenient times ― before a big presentation at work, for example ― and last anywhere from two minutes to 48 hours (in severe cases).

Hiccups feel funny at best and painful at worst. Chances are you’ve tried to get rid of them through some of age-old remedies: Have someone scare you! Hold your breath! Chug a glass of cold water!

But do these remedies actually work? And if not, are there methods that do? Let’s take a closer look.

Before we dive into remedies, let’s examine the underlying cause of hiccups. Are they really as random as they seem? The answer is probably yes.

“The reason behind hiccups is one of the great unknowns in the health world,” said Michael Richardson, primary care provider and office director at One Medical.

There are a few hypotheses, though. “Most theories center on the ‘hiccup reflex arc,’ which includes the phrenic nerve (the nerve that activates your diaphragm), the vagus nerve (the major nerve in your autonomic nervous system), and several other nerves that activate the muscles in your chest and larynx,” Richardson added. “If this reflex arc is irritated, either by trauma or inflammation, it can trigger a hiccup.”

The problem here is that hiccup triggers are different for different people, which is why they seem so random. Maybe your friend’s reflex arc is irritated by spicy food and carbonated water, but yours is irritated by stress at work. If you’re looking to get the bottom of why your hiccups happen, your best bet is to pay attention to any patterns around what triggers your hiccups.

When you’re in the thick of the hiccups, you probably don’t care much about where they come from ― you just want them to stop. The good news is that most cases of the hiccups will go away on their own in a reasonable period of time without any intervention from you.

But if you happen to have a case of the hiccups that’s lasting hours (it happens!) or just want them to get rid of them as soon as possible, there is some evidence to back up the common home hiccup remedies.

“There are not many high-quality studies looking at how to cure hiccups … but the ones out there support some of the home remedies we frequently hear about, such as holding your breath or being scared,” Richardson said. “The mechanism isn’t well understood, but they’re all probably an attempt to reset the hiccup reflex arc or alter our breathing pattern.”

Other natural hiccup remedies? Acupuncture, and maybe even sex.

“An interesting non-medication based strategy that has been shown to work is acupuncture, so that may be a go to option if the hiccups are plaguing you longer than expected,” Richardson said. “One case study reported that sex was the cure for one man’s intractable hiccups, but I wouldn’t hold my breath on this working for others.”

If you have the hiccups for more than 48 hours, this is considered “persistent hiccups,” and it’s probably worth checking in with your doctor about them —there are medications a doctor can prescribe you to help.

According to Beverly Hills-based primary care physician Ehsan Ali, some of the more harmful causes of the hiccups could include acid reflux, stomach distension, stomach irritation, stomach ulcers, electrolyte abnormality. They could also be a side effect of medication. And in rare cases, they’re a symptom of a more severe underlying illness.

If you have persistent cases of painful hiccups, that’s also an issue worth bringing to your doctor.

“Common hiccups typically should not be painful,” Ali said. “If this is happening to you, there may be something more serious going on and you should seek medical attention for a proper medical evaluation.”

For the most part, hiccups are a harmless, albeit annoying part of life. More research is needed to truly understand the underlying causes of hiccups and how to treat them. For now, it’s probably worth sticking with those tried-and-true home remedies when you want to get rid of them.

And if you don’t mind them, enjoy the bumpy, funny hiccup ride. Nature is pretty good at getting rid of them, too.