First Bite Syndrome

First bite syndrome causes mouth pain when salivating or taking the first few bites of a meal. This condition is a potential side effect of some head and neck cancer treatments. Head and neck tumors can cause first bite syndrome, too. Treatments may include medications or botulinum toxin injections.


People with first bite syndrome develop pain when salivating or first few bites of a meal
People with first bite syndrome develop pain when salivating or when taking the first few bites of a meal. In many cases, the condition is associated with parotid gland surgery or a parotid gland tumor.

What is first bite syndrome?

First bite syndrome is a 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 (it happens unilaterally). Many people describe the pain as a spasm or cramping sensation.

First bite syndrome doesn’t mean you have any additional health risks. However, it can certainly have a negative impact on your quality of life.

Who does first bite syndrome affect?

First bite syndrome may affect people who have:

  • Received treatments for head and neck cancers.
  • Certain head and neck tumors.
  • Undergone parotid gland surgery.
  • Had surgery in their parapharyngeal space (a pyramid-shaped area deep inside your head and neck).
  • Had surgery for carotid body tumors (growths in the blood vessels near your carotid arteries).

People can develop first bite syndrome symptoms within days, months or even years after surgical treatment. Keep in mind, though — even if one or more of the above apply to you, it doesn’t necessarily mean you’ll get first bite syndrome.

Is first bite syndrome rare?

Yes. While first bite syndrome is more common in people who’ve had surgery or cancer treatments for head and neck conditions, it’s a rare condition. The rarest type of first bite syndrome is idiopathic — meaning that it has no apparent cause.


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Symptoms and Causes

What are the symptoms of first bite syndrome?

First bite syndrome symptoms may include:

What causes first bite syndrome?

Experts believe that first bite syndrome is the result of nerve damage. This nerve damage may be the result of a head and neck tumor or a side effect after head and neck surgery.


Diagnosis and Tests

How is first bite syndrome diagnosed?

A healthcare provider can diagnose first bite syndrome during an examination. They usually don’t need to run tests, especially if you developed symptoms after a head and neck surgery. They’ll ask about your symptoms and health history to confirm your diagnosis.

But if you develop first bite syndrome for no apparent reason, your healthcare provider might need to rule out other conditions, such as temporomandibular joint (TMJ) disorders.

Management and Treatment

How is first bite syndrome treated?

In many cases, first bite syndrome symptoms go away on their own. So, your healthcare provider may choose to monitor your progress to see if treatment is even necessary.

If your symptoms come back (recur) or linger, first bite syndrome treatment may include:

Botulinum toxin injections

Botulinum toxin (Botox®) is a neurotoxin that blocks certain chemicals from nerves. Injecting botulinum toxin into your parotid gland can reduce or eliminate first bite syndrome symptoms. It’s the most effective nonsurgical treatment for first bite syndrome. You may need more than one injection, and you’ll likely need injections every few months to maintain results.


In some cases, combinations of anticonvulsants (such as carbamazepine) and tricyclic antidepressants (such as amitriptyline) can reduce the duration and intensity of pain from first bite syndrome. But medication can’t cure it.

Research shows that pain relievers, including NSAIDs (nonsteroidal anti-inflammatory drugs), aren’t effective in the treatment of first bite syndrome.

Lifestyle changes

Some people find relief by avoiding sour and acidic foods, which stimulate more saliva production. Additionally, chewing on the other side of your mouth that isn’t affected might ease your discomfort.

Radiation therapy

Radiation therapy isn’t a common treatment for first bite syndrome. But many people who’ve undergone radiation therapy to shrink a head and neck tumor have reported a reduction or total resolution of first bite syndrome.


If you’re unable to eat, or if you have severe pain, total parotidectomy (removal of your parotid gland) can be effective in treating first bite syndrome. This isn’t common and providers typically reserve it as a last-resort option.



Can I prevent first bite syndrome?

Because first bite syndrome is a side effect of head and neck tumors or cancer treatments, there’s nothing you can do to prevent it.

Outlook / Prognosis

Does first bite syndrome go away?

Sometimes, first bite syndrome goes away on its own. But in some cases, symptoms can last a long time. This might affect your quality of life. There’s no way to know if or when your symptoms will get better, so ask your healthcare provider how to manage your condition in the meantime.

Living With

When should I see my healthcare provider?

If you experience spasms, cramping or pain after taking the first few bites of a meal, talk to a healthcare provider. They can help confirm your diagnosis and determine appropriate treatment.

What questions should I ask my healthcare provider?

If you have first bite syndrome, you may want to ask your healthcare provider these questions:

  • Do you know what caused first bite syndrome?
  • Should I avoid certain foods?
  • Can treatment help? If so, what kind?
  • How often should I see you for follow-ups?

A note from Cleveland Clinic

First bite syndrome is a condition that can develop as a side effect of head and neck tumors or after head and neck surgeries and cancer treatments. It’s not dangerous, but it can have a negative impact on your quality of life. If you develop symptoms of first bite syndrome, tell your healthcare provider right away. They can help determine the cause and find ways to ease your symptoms so you can get back to enjoying life.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 01/15/2023.

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