Introduction <p>Trigeminal neuralgia is a chronic neuropathic pain disorder characterized by severe episodic facial pain and significant impairment in quality of life. Despite multiple available treatment options, comparative evidence on their clinical outcomes remains limited. This systematic review aimed to evaluate and compare outcomes of various medical and surgical treatment modalities.</p> Methods <p>A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of sciences and Scopus databases were searched for studies published between 2005 and 2025 using the terms “trigeminal neuralgia” combined with drug therapy, surgery, and radiotherapy. Randomized controlled trials and observational studies were included. Due to heterogeneity in study design, interventions and outcome reporting, findings were synthesized qualitatively. Outcomes assessed included pain relief, recurrence rate, patient satisfaction and treatment-related complications.</p> Results <p>A total of 7,842 records were identified, of which 8 studies met the inclusion criteria and were included in the final qualitative synthesis. The study population demonstrated a female predominance (65.5%) with a mean age of 58.4 years and the mandibular division was most commonly affected Variability was observed across treatment modalities in terms of onset of pain relief, recurrence rates, and complication profiles. Facial numbness was the most frequent complication, occurring in approximately 16% of patients.</p> Discussion and conclusion <p>Minimally invasive procedures provide effective short-term pain relief with higher recurrence rates, whereas microvascular decompression offers the most durable long-term outcomes despite greater invasiveness. Treatment should be individualized based on patient characteristics, disease etiology and expected durability of outcomes.</p>