The paroxysmal facial pain of trigeminal neuralgia is notoriously severe. Recent advances in medical science are achieving significant strides toward alleviating this incapacitating condition. High-resolution neuroimaging techniques are rendering detailed views of underlying neurovascular relationships. Newer antiepileptic medications and novel therapies are proving helpful in treating pain resistant to carbamazepine. Further developments also in targeted neurosurgical and radiosurgical techniques are providing pain relief within increasingly wider margins of safety. Much has been accomplished, yet much remains to be done.