Background Data: The most common cause of trigeminal neuralgia is neurovascular compression. However, several patients present with unknown etiology. Purpose: This study aims to investigate the relationship between trigeminal neuralgia and cervical pathology in patients previously diagnosed with idiopathic trigeminal neuralgia. Study Design: We designed an observational case-control study in our tertiary center. Patients and Methods: A study group consisting of patients previously diagnosed with idiopathic trigeminal neuralgia and a control group consisting of patients with tension-type headaches were included in the study. A blinded neuroradiologist reevaluated cranial MRIs of trigeminal neuralgia patients. Once it was confirmed that no signs of neurovascular compression or any secondary causes were present, a cervical MRI was performed to evaluate cervical pathologies. Cranial and cervical MRIs of the controls were evaluated by the same neuroradiologist. Results: Twenty patients who had prior diagnoses of idiopathic trigeminal neuralgia and 20 controls were investigated. The mean age of trigeminal neuralgia patients was 64.9 ± 12.6, and the mean age of the control group was 61.3 ± 9.1 (p = 0.305). The male/female ratio in trigeminal neuralgia patients was 2.3 and 1.8 in the control group (p = 0.736). While indentation on the trigeminal spinal tract above the C4 spinal level was observed in 12 out of 20 patients, none of the controls had any involvement in the same region (p < 0.001). Conclusion: The results of this study suggest that extramedullary indentation on the trigeminal spinal tract caused by upper cervical discopathy may be one of the possible etiological factors in trigeminal neuralgia. (2021ESJ244)