“When you hear hoofbeats, think horses, not zebras.” While this is a popular medical proverb, it can unfortunately lead many health practitioners down the wrong path in assessing certain pain syndromes. We will be discussing three pain conditions that are often mistaken for other more common pain diagnoses: thoracic outlet syndrome, piriformis syndrome, and occipital neuralgia. These must be considered in the differential diagnoses of upper extremity, lower extremity, or headache pain disorders, respectively. Clinical presentations, pathophysiologies, and the diagnosis and treatment of these conditions will be presented.