First Bite Syndrome

First bite syndrome is when you have pain in your mouth from salivating (when your mouth makes saliva, or liquid) or when you take the first few bites of your food. The pain can be intense, sharp, or like a muscle spasm. The pain is usually felt in the parotid (salivary gland) area, in the back of your mouth close to your ears. It is often only felt on one side. The pain lessens with each bite but will happen again if there is a pause in eating.

What causes it?

First bite syndrome can be caused by nerve damage during head and neck cancer surgery or from a head and neck tumor itself.

First bite syndrome can start anywhere from days, to months or years after surgery or diagnosis of the tumor. This side effect can get bettter on its own, but there are some treatments that can be helpful.

How is it treated?

There are a few ways to treat first bite syndrome, but each person may respond differently to the treatments.

• Changes in behavior: Some actions, like rubbing your face, clenching your fists, and stomping your feet can distract from the pain. If the pain is only on one side of your mouth, you can try chewing your food on the opposite side. You can also change your diet to avoid acidic and sour foods, which can stimulate (rev up) more saliva production, causing more pain.
• Medications: Research has shown that oral (taken by mouth) and topical (placed on the skin) pain medications and non-steroidal anti-inflammatory medications (NSAIDs) are not helpful in treating first bite syndrome. Some other types of medications can help with pain:
  • Carbamazepine, an anticonvulsant, has been shown to lessen the pain.
  • Amitriptyline, a tricyclic antidepressant, has been shown to reduce how long your pain lasts.
  • Gabapentin, an anticonvulsant used for nerve pain, can also help with pain.
• Radiation Therapy: Radiation is not often used to treat first bite syndrome but can be helpful in some cases. There are risks with radiation that do not always outweigh the benefits, since first bite syndrome may get better on its own.
• Surgery: Total parotidectomy has been shown to completely improve first bite syndrome, but it comes with many serious risks.
• Botulinum Toxin Injection: Botulinum toxin (Botox) is a protein that blocks the release of acetylcholine. The injection is given into the painful area in the parotid gland. The number of injections ranges from 1 to 3. The injections can be uncomfortable, but this is the only treatment that has been found to improve symptoms in most cases. In rare cases, these injections can lead to facial nerve injury and xerostomia (dry mouth). talk with your provider about how often these injections can be given.

First bite syndrome can affect your everyday life. Talk to your provider if you think you have first bite syndrome so that you can decide on a treatment plan together.