Trigeminal neuralgia also called tic douloureux leads to paroxysms of short–lasting but very severe pain. Between attacks, patients are usually asymptomatic, but a constant dull background pain may persist in some cases. The etiology of most cases of trigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nerve at the level of Ponto cerebellar region. There are a wide range of medical and surgical treatments available. The preferred medical treatment for trigeminal neuralgia consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. For patient’s refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma–knife surgery and microvascular decompression are the most promising invasive treatment options. This article bring about a retrospective study of 172 patients of trigeminal neuralgia treated by microvascular decompression and percutaneous radio frequency thermocoagulation at a tertiary institute.