Trigeminal neuralgia, or tic douloureux, is 1 of the most debilitating disorders known and has been described as the most excruciating pain that humans may experience. This very intense pain results from irritation of the trigeminal nerve, which branches across the forehead, cheek, and lower jaw.  It may have a specific pathophysiology and it does have a primary order of treatment. Atypical facial pain is very different, not a cranial nerve neuropathy, and must be differentiated from trigeminal neuralgia. We will discuss these differences as well as other cranial nerve neuropathies, their diagnoses, and treatment paradigms.