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Thoracic outlet syndrome (TOS) comprises of either neurogenic, arterial or venous compression which can occur at several sites in the thoracic outlet, of which arterial TOS is the rarest form. Anatomical causes include presence of cervical ribs, untreated clavicular fractures, clavicular pseudoarthrosis and first rib pseudoarthrosis. We present the case of a patient with bilateral clavicular and first rib pseudoarthrosis who presented with arterial TOS, with no anatomical causal relationship between the clavicular pseudoarthrosis and the TOS, but rather with the first rib pseudoarthrosis resulting in an abnormal rib curvature which was thought to be contributory to the TOS. [ABSTRACT FROM AUTHOR]

Chronic headache can be a presenting manifestation of Takayasu arteritis, although patients usually have other characteristic features. A thorough clinical assessment remains key in the evaluation of chronic headache., Competing Interests: The authors have no conflicts of interest to declare., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)