First Bite Syndrome

First bite syndrome (FBS) is a rare condition in which you experience mouth pain when salivating or taking the first few bites of a meal. As you continue to eat, symptoms go away. Discomfort typically develops near your parotid glands or along your lower jaw. First bite syndrome usually only affects one side of your face. Many people describe the pain as a spasm or cramping sensation.

First bite syndrome is most often an uncommon side effect of surgery to your head and neck. Often, it gets better with time and doesn’t pose health risks. But it can have a negative impact on your quality of life while symptoms last.

Your healthcare provider can suggest treatments that can help.

Symptoms of first bite syndrome

This condition causes sharp pain or cramping in your jaw upon your first bite of food. Symptoms improve as you keep eating. The pain may:

• Spread (radiate) to your ear and sometimes your neck
• Last several seconds up to a few minutes
• Feel worse when you eat acidic, sour or very cold foods

For some people, FBS symptoms are mild enough to ignore. For others, the pain is so intense that they dread mealtimes. Without treatment, it can lead to anxiety about food.

First bite syndrome causes

Experts believe that it happens due to nerve damage. Usually, it’s a side effect after head and neck surgery. This nerve damage may also result from a head and neck tumor.

It may happen if you have/had:

• Treatments for head and neck cancers
• Parotid gland surgery
• Surgery in the parapharyngeal space (a pyramid-shaped area deep inside your head and neck)
• Surgery for carotid body tumors (growths in the blood vessels near your carotid arteries)
• Certain head and neck tumors, both cancerous and benign

You can develop first bite syndrome symptoms within days, months or even years of having surgery. But keep in mind — even if one or more of the above conditions or treatments apply to you, that doesn’t mean you’ll get first bite syndrome.

Complications of this condition

First bite syndrome can be serious if the pain is so severe that you skip meals. This is especially the case when it’s related to cancer or cancer treatment.

Your body needs healthy foods to heal. This is why it’s important to see a healthcare provider if FBS symptoms are keeping you from getting the nutrition you need.

How doctors diagnose this condition

Your healthcare provider can diagnose first bite syndrome by asking about the symptoms you’ve experienced and your health history. They usually don’t need to run tests, especially if you develop symptoms after a head and neck surgery.

But if you have first bite syndrome for no apparent reason, your healthcare provider might need to rule out other conditions.

How is first bite syndrome treated?

In many cases, FBS symptoms go away on their own. So, your healthcare provider may choose to monitor your progress to see if you even need treatment.

If your symptoms come back or linger, treatment may include:

• Botulinum toxin (Botox®): This is the most common and most effective treatment. Injecting botulinum toxin into your parotid gland can reduce or get rid of symptoms. You’ll likely need injections every few months to maintain results. Injections may be performed using ultrasound.
• Surgery to remove tumors: Removing tumors that are causing first bite syndrome usually gets rid of the pain.
• Certain oral anti-seizure medications or tricyclic antidepressants: This is less common than Botox treatment but can be effective in some people.
• Acupuncture: This treatment inserts thin needles into specific points in your body to relieve pain.
• Nerve blocks: This type of injection provides temporary pain relief.

When should I see my healthcare provider?

If you have spasms, cramping or pain after taking the first few bites of a meal, talk to a healthcare provider.

The over-the-counter pain relievers many of us rely on when we’re in pain don’t help with first bite syndrome. You’ll need to see a provider to confirm your diagnosis and find the right treatment.

Does first bite syndrome go away?

Sometimes, FBS goes away on its own. At the very least, symptoms often improve in most people. But in some cases, symptoms can last a long time. Research shows that when symptoms get better on their own, the timeline can range from within one to 18 months.

Symptoms might affect your quality of life. And there’s no way to know for sure if or when they’ll get better. It’s best to ask your healthcare provider how to manage your condition in the meantime.

Can first bite syndrome be cured?

There isn’t a single medical cure. And there’s no guarantee that it’ll go away for good. But for most people, symptoms get better eventually. In the meantime, treatments like Botox® injections can relieve the pain.

Is there anything I can do to feel better?

Some people with mild symptoms manage FBS by changing what and how they eat. You can:

• Chew on the side of your mouth that doesn’t hurt.
• Reduce sour or acidic foods, which stimulate more saliva production.
• Distract yourself from the pain by clenching your fist during the first several bites.