We often come across patients with presentation of facial pain, but unless this is sinugenic in origin, our understanding and management of it can often be found wanting. Craniofacial pain is in fact highly complex and encompasses a wide range of causes including trigeminal neuralgia, and atypical facial pain (aka persistent idiopathic facial pain). Treatment with medications alone can often have suboptimal results. Tolerance, dependence and side-effects of these medications often provide patients with an impetus to steer towards the surgical options. This review aims to cover the surgical alternatives and discusses patient selection, risks, and benefits associated with each of these therapies. The interest in management of craniofacial pain has gained momentum in recent years within neurosurgical circle and is being explored at a rapid pace. As a specialty, it’s important for us to be able to appreciate that beyond amitriptyline, gabapentin and pregabalin, our neurosurgical colleagues might just have that extra trick in their sleeves in peripheral nerve stimulation (PNS), ganglion stimulation (e.g. sphenopalatine ganglion), microvascular decompression (for trigeminal neuralgia) and deep brain stimulation.