Trigeminal neuralgia is considered to be one of the most severe forms of pain in the human experience. In this discussion, classical neurology, current advances in medical science, and the relief of human suffering converge in a single nerve. Improvements in the resolution of neuroimaging have elucidated neurovascular relationships in striking detail. The availability of new antiepileptic medications has expanded the range of therapeutic options for patients whose pain cannot be controlled by first-line agents. Further developments in neurosurgical and radiosurgical techniques have provided effective treatments with increasingly wider margins of safety. Significant advances in cortical stimulation technology are also making headway into pain relief and delineating the central mechanisms of chronic neuropathic pain.