Unrecognized and untreated black widow spider bites cause significant pain, impairment, and rarely death. The widow venom, a powerful neurotoxin known as a-latrotoxin, causes muscle pain, diaphoresis, tachycardia, flushing, and hypertension. Treatment is usually symptomatic with a combination of opioid analgesics and muscle relaxants. If symptom resolution fails, an equine IgG antiserum is available, but a high index of clinical suspicion coupled with a knowledgeable patient history often allows successful treatment, especially when the treating physician possesses awareness of this type of bite and its usual course and possible complications.