True neuralgia of the superior laryngeal nerve is a distinct clinical entity comparable to trigeminal and glossopharyngeal neuralgia. It is characterized by paroxysms of unilateral, lancinating pain, which radiates from the side of the thyroid cartilage to the angle of the jaw and sometimes to the ear. There is a trigger zone at the plica of the nerve in the pyriform sinus. The pain is ordinarily initiated by swallowing but can be produced by touching the trigger zone with a probe. The other objective finding is a pressure point on the skin surface just above and lateral to the thyroid cartilage, where the sensory branch of the nerve pierces the hyothyroid membrane. Between the seizures, which may last from a few seconds to a minute, the patient is free from discomfort. As in other cranial nerve neuralgias, the attacks usually appear after middle age and increase in frequency and intensity.