Pain When Swallowing: Causes, Relief, and Treatment

Difficult or painful swallowing is a common symptom of strep throat or the common cold. However, it can have a variety of other causes as well.

Depending on the underlying cause, you may also experience:

• Pain in your mouth or esophagus
• An earache
• Throat pain on one side more than the other

You should see a doctor if you aren’t sure what’s causing pain when you swallow or if you have severe symptoms such as a high fever.

Why it Hurts to Swallow: 8 Potential Causes

Here are seven potential reasons it might hurt to swallow:

1. Cold or Flu

A sore throat is often one of the first symptoms of an oncoming cold or sinus infection. This condition can make swallowing difficult or painful. It may start a day ahead of other symptoms, which may include:

• Runny nose
• Coughing
• Sneezing
• Headache
• Fever and chills
• Earache (generally due to pressure)

The flu generally causes similar symptoms but tends to be more severe (though a runny nose is less likely). You may develop a high-grade fever and notice muscle aching or soreness throughout your body.

For colds and sinus infections, at-home sore throat remedies are usually best. If you suspect you may have the flu, you should see a doctor.

2. Strep Throat

Strep throat is another common cause of painful swallowing. Unlike a cold or the flu (caused by viruses), strep comes from bacteria.

A sore throat caused by strep is usually accompanied by:

• Fever
• Fatigue
• Swollen lymph nodes in the front of the neck
• Swollen tonsils, which may be red or have white spots
• Vomiting (in young children)

Healthcare providers often use a throat swab to test for strep throat. Because strep is a bacterial infection, healthcare providers can treat it with antibiotics.

3. Mononucleosis

Mononucleosis (mono or glandular fever) is a common viral infection. Most people are infected with the Epstein-Barr virus (EBV) as children, which tends to cause few symptoms, if any.

However, being infected with EBV as an adult can cause mononucleosis. Symptoms include:

• Sore throat
• Fever
• Swollen lymph nodes
• Fatigue
• Swollen liver or spleen (in more severe cases)

Mono often spreads through contact with the saliva of someone infected. A person can be infectious weeks before they even begin to show symptoms.

Within 2 to 4 weeks, mono usually subsides on its own. You can help recovery by getting plenty of rest and using over-the-counter (OTC) pain medication and home remedies as needed.

4. Tonsillitis

Various viruses can cause tonsillitis (tonsil inflammation). It can also be a strep throat symptom.

Sometimes other bacteria may cause tonsillitis as well. Signs you may notice include:

• Sore throat and trouble swallowing
• Visibly swollen tonsils, which may be red and/or spotted
• Fever
• Swollen lymph nodes

Tonsillitis often resolves on its own within a week. Rest and OTC pain medication can help alleviate symptoms.

5. Acid Reflux (GERD)

Acid reflux occurs when food and stomach acid flows up into your esophagus. It usually causes heartburn and an acidic taste but may also cause a sore throat and difficulty swallowing.

It’s possible only to experience acid reflux occasionally, but if it happens regularly, you may be diagnosed with gastroesophageal reflux disease (GERD). GERD may cause other symptoms, such as:

• Nausea
• Chest pain
• Globus sensation (the feeling of an obstruction in your throat even if there is none)
• Salivating more than normal

Treatment for GERD may include limiting high-fat or acidic foods, avoiding alcohol, and taking a specific medication. In severe cases, your healthcare provider may recommend surgery.

6. Throat Injury

It’s possible to get a minor throat injury from swallowing a pill or a jagged piece of food. Drinking plenty of water when taking medications can help prevent this.

If you’ve already begun to experience pain after swallowing food or a pill, it should subside over time. Drink water and avoid anything else irritating your throat until it feels better.

7. Allergies

An allergic reaction can sometimes cause pain or difficulty when swallowing. As your body reacts to the allergen, your throat may swell or fill with mucus.

Depending on the specific allergy, the issue may subside with time. But if you have an allergic reaction that makes breathing difficult, get medical attention immediately.

Other Causes

Here are some less common causes of pain when swallowing:

• COVID-19
• A peritonsillar abscess (a complication of strep throat or tonsillitis)
• Herpes simplex virus
• Oral thrush
• Esophagitis (can occur due to GERD, certain medications, or allergies)
• Crohn’s disease (typically affects the colon but can sometimes cause symptoms similar to GERD)
• Throat or esophageal cancer
• Chemotherapy or radiation therapy for cancer

Home Remedies for Throat Pain Relief

If your swallowing pain is mild or has just begun, you can try a home remedy to relieve discomfort. Some of the most effective and commonly used treatments for throat pain include:

Pain Medication

NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen (Aleve) can reduce inflammation, swelling, and pain. Tylenol, while not an NSAID, can also provide pain relief.

Be sure to follow the instructions when using OTC pain relievers, and talk to your doctor before using them if you have any chronic health conditions.

Antacids

Antacids are OTC medicines that counteract your stomach acid. This reaction can relieve indigestion or acid reflux.

Throat Sprays

OTC throat sprays numb the throat, making it easier to swallow.

Saltwater Gargling

Saltwater can reduce inflammation and offer mild pain relief. Unlike the OTC medications listed above, you can gargle salt water several times daily.

Warm Beverages

Sipping warm tea or water is an excellent at-home remedy for throat pain. Mixing in honey and lemon can provide extra relief as well as flavor.

Hot Shower or Steam

Breathing in warm steam can ease throat pain. It can also provide temporary relief for nasal and chest congestion. Taking a hot shower will relieve sore muscles and chills if you have a cold.

Avoid Throat Irritants

If you experience pain when swallowing, you should avoid things that might worsen it, such as:

• Alcohol
• Smoking or vaping
• Hot or spicy foods
• Hard or rough foods

In general, it’s best to stick to fluids and soft foods when your throat is sore, or swallowing is painful.

Many people use cold foods like smoothies or ice cream to relieve throat pain. But they may not help or even make things worse. Use caution and stop eating if the pain or discomfort is overwhelming.

When to See a Doctor 

Pain when swallowing isn’t always a cause for concern. In many cases, throat pain eases as the cold or other illness improves. If you’ve swallowed wrong or coughing hurts your throat, it’ll likely feel better in a day or two.

In some cases, however, you’ll need prescription medication to resolve throat pain. This is especially true with strep throat and other bacterial illnesses.

No matter what you think the cause of your difficulty swallowing is, you’ll want to see a healthcare provider if you:

• Don’t have other symptoms or an apparent cause
• Experience pain that lasts more than a week or only seems to get worse
• Have difficulty breathing
• Have problems opening your mouth
• Notice swollen lymph nodes that don’t ease after a few days
• Are coughing up or vomiting blood

Diagnosing the Cause of Painful Swallowing

Your healthcare provider may use several tools to diagnose the cause of your pain when swallowing. These include:

Throat Culture

Taking a throat culture means collecting a small number of cells from the back of your throat. Your doctor may use a long swab to get a sample and culture it to see if specific viruses or bacteria are present.

Blood Test

Your doctor might take a blood sample to determine your white blood cell count. This test can help decide whether or not you have a bacterial infection.

CT Scan

A CT scan uses a machine to create an image of your throat, allowing your doctor to look for abnormalities, such as an abscess or tumor.

Barium Swallow

An esophagogram or barium swallow is an X-ray that allows a doctor to view your throat and esophagus internally. It helps evaluate your swallowing function. You’ll drink a special liquid beforehand to make it easy to view the path that food takes from your mouth to your stomach.

Treatment Options and Outlook 

Treatment for painful swallowing will vary according to the underlying cause. Often, healthcare providers prescribe antibiotics because swallowing pain is related to a bacterial infection such as strep throat.

Other possible treatment options include:

• Antihistamines (OTC or prescribed)
• Tonsil removal (in cases of severe recurring tonsillitis, especially in children)
• Antifungal medications (for oral thrush)
• Prescription pain medication

However, in many cases, time, rest, and adequate food and water are enough to alleviate throat or swallowing-related pain. Talk to your doctor about your options if you have chronic or severe difficulty swallowing.

Summary 

Pain when swallowing can have various causes, including viral or bacterial infections, acid reflux, swallowing rough food or pills, and allergies. Depending on the reason, you may have other symptoms, such as throat swelling, a fever, or a cough.

The pain will usually gradually disappear within one to two weeks. However, you should see your doctor if your symptoms are overwhelming or severe. You may be given antibiotics or other treatments depending on the severity of your condition.