Trigeminal neuralgia is defined as paroxysmal attacks of painful sensation usually lancinating or electrical in quality lasting from few seconds to less than a minute. Pain involves the distribution of trigeminal nerve more in lower face than forehead. Idiopathic trigeminal neuralgia affect females more than males in a ratio 2:1 to 4:3 70% of patients are over 50 years of age. Different theories describe the etiology of trigeminal neuralgia including vascular compression theory (Dandy, 1934) was the first to describe such neurovascular relationship until Jannetta (1980) stated that idiopathic trigeminal neuralgia is due to pulsatile-compression or cross compression by the arteries at root entry of exit zone. Other factors may contribute such as multiple sclerosis, herpes simplex or mass lesions in CPA. Diagnosis of trigeminal neuralgia is a matter of exclusion and careful follow-up and based on the history as regard onset, course, duration, and character of pain along with full neurologic examination. Various investigations are done to confirm the diagnosis include MRI brain, CT scan and cerebral angiography, they also help to exclude other pathology as cerebellopontine angle tumour.Different types of treatment options used and include medical and surgical treatment. Medical treatment, includes carbamazepine and phenytoin found to be effective in pain control in about 80% of cases, the former being more effective baclofen and clonazepam found to be of valve in patient for whom carbamazepine and phenytoin provide no adequate pain relief or not tolerated. Surgical procedures include: destructive procedures include injection of alcohol along trigeminal pathway, infraorbital and supraorbital injection can be given quickly in an outpatient setting, well tolerated by patient and injection can be repeated if the tic returns. The main disadvantages are the temporary sensory loss or parathesia and recurrence of tic douloureux.