Trigeminal neuralgia is a rare but debilitating pain syndrome with a distinct clinical presentation mainly affecting people advancing in years. Compression of the trigeminal nerve by an aberrant vascular loop has been proposed as the causative factor in the majority of cases leading to the development of a highly effective surgical treatment approach termed "microvascular decompression". Nevertheless the mainstay of treatment remains medical. This article gives a brief overview of current treatment options for trigeminal neuralgia with special emphasis on radiosurgery. Possible mechanisms underlying the therapeutic effect of radiosurgery are discussed with some consideration of implications for optimizing prescription dose and target definition.