Background: Trigeminal neuralgia typically manifests as muscle twitching or severe hemifacial discomfort. Despite not being a life-threatening illness, the morbidity can be quite crippling and interfere with daily activities, including job. The present study was conducted to assess causes of Trigeminal neuralgia using MRI. Materials & Methods: 74 patients presenting with clinical symptoms of unilateral trigeminal neuralgia of both genders underwent MRI using a 1.5 Tesla, Philips multiva system. A high resolution 3D T2 DRIVE or 3D bFFE cranial nerve sequences were performed in addition to the routine Magnetic Resonance (MR) sequences. MR severity grading of neurovascular compression of the trigeminal nerve was as Grade 0- A vascular loop is seen in the prepontine cistern, but not abutting the nerve, Grade 1- Vascular loop abutting the nerve (root entry zone or the cisternal segment) without nerve displacement or atrophy, Grade 2- Vascular loop causing mild indentation of the nerve, Grade 3- Vascular loop significantly displacing the nerve, without nerve atrophy, Grade 4- Vascular loop significantly displacing/distorting the nerve with signs of nerve atrophy. Results: Out of 74 patients, 44 were males and 30 were females.MRI findings showed neurovascular compression in 54, benign intracranial hypertension in 7, trigeminal pontine sign in 4, no specific findings in 9 patients. The difference was significant (P< 0.05). Neurovascular compression grade 1 was seen in 23, grade 2 in 17, grade 3 in 10 and grade 4 in 4 patients. The difference was significant (P< 0.05). Conclusion: The clinician can completely relieve the patient's symptoms by determining reversible aetiologies, such as benign intracranial hypertension. A customized MRI can show both typical and uncommon causes of trigeminal neuralgia in the majority of instances, which helps the clinician treat the patient appropriately.