Although jaw claudication is frequently included in symptoms referable to extracranial carotid disease, not a single case in the United States literature has ever been reported. A 77-year-old woman with a history of severe cardiovascular disease presented with disabling bilateral jaw claudication roughly a quarter of the way into every meal. Symptoms were present for approximately 1 year. She denied previous transient ischemic attack or stroke. Carotid duplex scan and subsequent angiogram revealed bilateral high-grade ostial stenoses of the external carotid arteries. Previously occluded right internal carotid artery appeared to be recanalized and functionally occluded. The left internal carotid artery appeared with ∼65% heavily calcified stenosis. A left internal/external carotid endarterectomy with Dacron patch closure was performed. The operation resulted in immediate and complete resolution of bilateral jaw claudication on a regular diet. At 9 months after surgery, the patient remains asymptomatic, and follow-up duplex scan demonstrates no external carotid restenosis (Fig). Symptoms of jaw claudication should alert the clinician to evaluate for external carotid artery occlusive disease. Unilateral endarterectomy may result in complete symptom resolution as a result of extensive collateralization between both external carotid arteries.