Facial pain is a rare and often misdiagnosed condition. The most common facial pain syndrome is trigeminal neuralgia (TG), which is characterized by paroxysms of excruciating, sharp, burning or lancinating pain. Most cases are caused by a vascular compression of the trigeminal nerve at its entry zone to the pons. Treatment strategies comprise medical treatment and surgical procedures. Anticonvulsants like carbamazepin or gabapentin are widely used for the treatment of TG. The decision on the individual drug therapy may depend on factors like pharmacokinetic properties and individual drug tolerability. In case of drug failure, surgical treatment options like microvascular decompression are available. Persistent idiopathic facial pain is a rare pain condition. Elaborate diagnostic investigations have to be performed since symptomatic causes may be overlooked. Antidepressant drugs like amitriptyline are the first-line drugs for the treatment of this condition.