Trigeminal neuralgia is a rare form of neuropathic pain that results in sudden, usually unilateral, severe, brief stabbing, recurrent pains in the distribution of one or more branches of the fifth cranial nerve. Diagnosis of all orofacial pain is principally on careful historic assessment because there are few investigations with high specificity and sensitivity. Management of trigeminal neuralgia is initially medical with the "gold standard" drug being carbamazepine. More drugs are now available, but relatively few have been evaluated in high-quality, randomized, controlled trials. Surgical treatments have yielded favorable outcomes, especially microvascular decompression, but evidence has come only from case reports. Other forms of facial pain respond to tricyclic antidepressants, but invasive occlusal rehabilitation for temporomandibular disorders must be avoided. Patients require high-quality information. National support groups are available. © 2004 Elsevier Inc. All rights reserved.