Pain When Swallowing: Common Causes and When It's Urgent

Pain when you swallow (odynophagia) is most often caused by a throat infection from a cold, strep throat or tonsillitis. Other causes include acid reflux, scratches from food and irritation from pills.

Viral infections like a cold usually clear up in a week. Get emergency care if you can’t swallow liquids or saliva, or have trouble breathing.

Odynophagia can come with problems swallowing food (dysphagia). If you have pain on just one side of your throat, the likely causes are different.

Why It Hurts to Swallow

Pain high in your throat often comes from an infection. If the pain is lower, behind your breastbone, it may be in your esophagus, the tube that carries food to your stomach.

1. Cold or Flu

Sore throats are common with colds and with the flu and COVID-19, which tend to cause more severe symptoms. You can only tell the difference between the flu and COVID-19 with a test.

Contact a doctor right away for the flu if you’re at increased risk for complications, very sick or concerned. Prescription antiviral medicines work best if you start them within one to two days.²

2. Strep Throat

Group A strep is the top bacterial cause of sore throats. But it’s only responsible for 20-30% of sore throats in children and 5-15% in adults.⁴

Strep throat usually includes:

• Fever
• Red, swollen tonsils with white patches
• Swollen lymph nodes on the front of your neck
• No cough or runny nose

You can get a quick strep test with a throat swab and take antibiotics if needed.

3. Tonsillitis

Tonsillitis is swelling of your tonsils, usually from a virus but sometimes from strep. Your tonsils will be red, with or without a white or yellow coating.

Tonsil stones are another cause of white spots on your tonsils. They aren’t contagious and sometimes can make swallowing uncomfortable.

4. Mononucleosis

Mono is a viral infection, usually from Epstein-Barr, that spreads through saliva but can take several weeks to cause symptoms.

Symptoms include:

• Sore throat that lasts a while
• Fever
• Swollen lymph nodes
• Extreme tiredness

Most people feel better in two to four weeks but some are tired longer. Don’t play contact sports until your doctor says it’s OK because a blow to your belly could rupture your spleen if it’s swollen.

5. Acid Reflux (GERD)

Stomach acid that backs up into your esophagus can irritate it so that swallowing is painful lower in your chest. If reflux happens often or for weeks at a time, you may have GERD (gastroesophageal reflux disease). Either way, see a doctor if reflux makes swallowing hurt.

Other signs include:

• Heartburn
• Sour taste in your mouth
• Feeling like you have a lump in your throat

Acid reflux can cause chest pain. But call 911 for any new, severe or unexplained chest pain or pressure, especially if you have shortness of breath, sweating, nausea, lightheadedness or pain spreading to your arm, jaw, neck or back.

Frequent acid reflux can also wear away tooth enamel, so your dentist may be able to spot it.

6. Throat Injury From Food or Pills

Swallowing a sharp chip can scratch your throat. Or a pill can stick on the way down and irritate your esophagus, sometimes causing an ulcer. A scratch should be better in a day or two, but pill irritation can take longer to heal.

Take pills with a full glass of water and don’t lie down right afterward. See your doctor if the pain lasts more than a few days or gets worse. If a pill caused it, your doctor may switch the medicine or change how you take it.

If sharp pain starts after eating fish or chicken, you may have a bone stuck in your throat, so go to the emergency room now.

7. Allergies

Seasonal allergies are more likely to cause postnasal drip that makes your throat raw and scratchy rather than painful. The drip can make small bumps on the back of your throat, called cobblestone throat.

Call 911 if you suddenly have swelling in your throat, tongue or lips with problems breathing or swallowing. That can be a sign of a severe allergic reaction called anaphylaxis.

Less Common Causes of Painful Swallowing

If swallowing hurts but you aren’t feeling sick, acid reflux, a pill or allergies are the most likely reasons. Less common causes include:

• Esophagitis: Inflammation of your esophagus from acid reflux, certain medicines or an infection.
• Eosinophilic esophagitis: Inflammation from an allergy that can make food feel stuck in your esophagus.
• Yeast infection: in the mouth and throat (thrush)
• Mouth sores: due to herpes and other viruses
• Wisdom tooth infection: pericoronitis, an infected flap of gum over a partly erupted wisdom tooth, may also make your mouth hard to open
• Cancer: Throat cancer and esophageal cancer are rare. Painful or difficult swallowing that won’t go away should still be checked, especially with weight loss, hoarseness, bleeding or a neck lump.

Home Remedies for Throat Pain Relief

Viral infections cause most sore throats, and they usually get better after a few days of home treatment. Try:

• Pain relievers: Ibuprofen, naproxen sodium, or acetaminophen, as directed on the label. Talk to your doctor first if you have kidney disease, liver disease, or stomach problems.
• Warm salt water: Gargling a few times a day
• Warm drinks and honey: Tea or broth with honey. Don’t give honey to babies younger than 1 year.¹¹
• Cold foods: Ice chips or popsicles
• Throat sprays and lozenges: Temporarily soothe your throat. Don’t give lozenges to children younger than 4, and follow the age limits on the label.
• Antacids: to ease pain from acid reflux
• Cool-mist humidifier: Run a clean one, or take a warm shower to ease throat dryness. But avoid hot steam and steam vaporizers around children, due to the risk of burns
• Skip irritants: Avoid alcohol, smoking and vaping, spicy foods, and chips

How a Doctor Diagnoses Painful Swallowing

Your doctor will ask about your symptoms and examine your throat, mouth, and neck. If the cause isn’t clear, you may need tests, such as:

• Throat swab: A rapid strep test takes minutes, while a culture takes a day or two but catches more. A child aged 3 or older with symptoms and a negative rapid test should also get a culture.⁴
• Blood test: Looks for mono or other signs of infection or inflammation
• Upper endoscopy: A thin tube with a camera looks inside your esophagus when symptoms suggest reflux complications or don’t improve with treatment
• Barium swallow or CT scan: Imaging to look for narrowing, an abscess, or a growth

Treatment Options and Outlook

Treatment depends on the cause. Most sore throats are caused by viruses and don’t respond to antibiotics. Antibiotics are used to treat strep throat or other confirmed or strongly suspected bacterial infections.

Other treatments may include:

• Acid-reducing medications to treat GERD
• Antifungal medications for thrush
• Antihistamines to treat mild allergic reactions, or an epinephrine injection and emergency treatment for anaphylaxis
• Removal of your tonsils if you get tonsillitis often

Your doctor will want to see you if your sore throat hasn’t gone away after a week (or a few weeks if you have mono).

When to See a Doctor

A viral sore throat usually eases within a week. See a doctor if it lasts longer, keeps getting worse or comes with any of these signs.¹¹

Call 911 for These Symptoms

Call 911 or go to the emergency room for:

• Trouble breathing, or a throat that feels like it’s closing
• Not being able to swallow liquids or your own saliva, or drooling because you can’t swallow
• Sudden swelling of your lips, tongue or throat, especially after a food, medicine or insect sting
• New, severe or unexplained chest pain or pressure, especially with shortness of breath, sweating, nausea, lightheadedness, or pain spreading to your arm, jaw, neck or back
• A bone or other sharp object you think is stuck in your throat
• Food that stays stuck after eating, even if you can still swallow saliva

For swelling that makes it hard to breathe or swallow, or for chest pain, call 911 instead of driving yourself. If you have an epinephrine auto-injector and suspect a severe allergic reaction, use it right away, then call 911.⁹

Get Care the Same Day for These Signs

See a doctor or urgent care today if you:

• Find it harder and harder to drink but can still swallow, or you’re urinating less than usual
• Struggle to open your mouth fully
• See blood in your saliva or phlegm
• Notice a rash or joint pain

Call your baby’s doctor right away for a fever of 100.4°F (38°C) or higher in a baby 3 months or younger. A rectal reading is most accurate at this age, but don’t delay calling to take one.

Book an Appointment If You Notice

• Painful swallowing with no cold to explain it
• Food that sometimes sticks but then goes down, or unexplained weight loss
• Hoarseness or a neck lump that doesn’t go away
• Heartburn that happens often or for weeks at a time, or reflux that antacids don’t control
• Sore throats that keep coming back
• Pain around a wisdom tooth, which a dentist should check. Get same-day dental care if the gum around it swells