Background <p>Radiofrequency rhizotomy (RFR) has shown effectiveness for medically refractory trigeminal neuralgia patients; however, implementing RFR in low-resource settings could serve as a viable treatment option.</p> Objective <p>To evaluate the safety and efficacy of RFR as a trigeminal neuralgia (TN) treatment in low-resource centers and identify treatment outcome predictors.</p> Methods <p>A retrospective study was performed for 53 medically refractory TN patients who underwent RFR. Demographics, pain scores, complications, and outcomes were extracted and analyzed.</p> Results <p>Over 93% of patients significantly reduced visual analog pain scores (VAS) post-intervention (t = 34.64, df = 52, <i>p</i> &lt; 0.001) with a mean difference of 6.66 (95% CI 6.27–7.05) and a Cohen’s d value of 5.54 (95% CI 4.26–6.83), emphasizing clinically meaningful pain reduction with 2.8% recurrence at 12-month follow-up, and higher pretreatment pain scores were linked with recurrence risk (OR = 3.3, 95% CI 1.08–14.88, <i>p</i> = 0.067). Age, gender, and TN distribution are recurrence risk-independent. Similarly, multiple linear regression showed no relationship for the post-procedural pain predictors, such as age (β = − 0.01453, <i>p</i> = 0.5019) and voltage (β = 0.01197, <i>p</i> = 0.7547); however, baseline pain score was positively associated with post-procedural pain score (β = 0.526, <i>p</i> = 0.0168), showing it as a key determinant. Kaplan-Meier described the insignificant recurrence-free survival difference (<i>p</i> = 1), suggesting successful outcomes over follow-up, while complications were 39.6% of patients with predominant temporary jaw weakness.</p> Conclusion <p>Radiofrequency rhizotomy is a safe, effective TN management procedure in low-resource settings, highlighting the potential need for functional neurosurgery in developing healthcare systems.</p>