If you see patients who have pain from their neck and shoulder, radiating down the arm and into their fingers, they may have neurogenic thoracic outlet syndrome. Occipital headaches, arm weakness, and chest wall pain often coexist. This syndrome targets women and can occur after motor vehicle accidents. This complex spectrum disorder provokes controversy; in fact, it may be the most controversial diagnosis in medicine. Yet, the evidence demonstrates that if left untreated, quality of life is impaired as much as having chronic heart failure. This presentation will discuss common symptoms, etiology, diagnosis, and treatment options, including onabotulinumtoxinA therapy.