Trigeminal neuralgia is a sudden, severe, brief, recurrent, stabbing pain in the distribution of the trigeminal nerve. It is a rare condition whose etiology remains unknown. Diagnosis is by careful history and there are few investigations that are of value in the management of this condition. Management is initially medical with anticonvulsant drugs being the primary drugs. If the drugs are no longer effective or tolerated then surgical management needs to be considered. Surgery can be at a variety of different levels along the pathway of the trigeminal nerve. Each procedure has its advantages and disadvantage. It is crucial that throughout treatment the patient has been given fully informed choice.