A 39-year-old woman presented with a 2-month history of intractable, left-sided facial pain. A CT scan of the thorax disclosed a large lung mass surrounding supra-aortic vessels and hilus. The symptoms underwent a rapid and spontaneous remission after laryngeal nerve palsy with dysphonia developed. Referred facial pain secondary to the compression of the vagus nerve can rarely be the first manifestation of an underlying lung cancer. All cases of unexplained unilateral facial pain should be investigated for a mediastinal pathology, especially in smoker subjects.