Tolosa-Hunt syndrome (THS) is a condition that includes recurrent attacks of retro-orbital, steady, and severe pain usually as the presenting symptom. Symptoms may include spontaneous recurrence of pain, chronic pain, and cranial nerve dysfunction that are responsive to steroid treatment. A patients with THS is described, with findings on craniotomy and biopsy, and the typical presentation of acute pain and recurrence of pain associated with response to steroid treatment. An overview of pain in this condition is presented.