Background: Trigeminal neuralgia (TN), or Tic Douloureux, is one of the most common neuropathic pains. Gamma knife stereotactic radiosurgery (GNSRS) has been considered one of the procedures for treating primary TN. Objective: This study evaluates the effectiveness of GNSRS in treating primary TN in patients who are unresponsive to medical treatment in a single-center experience. Subjects and Methods: This study was conducted on 180 patients from January 2018 to October 2021. The study utilized the Barrow Neurological Institute (BNI) pain intensity score to assess pain before and after GNSRS treatment. Results: A total of 180 patients with primary TN were included in this study, 108 female with a 1.5:1 female: male ratio.  Results showed significant pain score reduction post-GNSRS, indicating GNSRS as an effective second-line treatment for primary TN. The study suggests GNSRS's potential in decreasing medication dosage with minimal short-term complications, recommending further research to assess long-term benefits and side effects. A notable decrease in medication usage was reported, with minimal short-term complications. These results support the consideration of GNSRS as a viable alternative for TN patients who have exhausted traditional treatment options. Further research is recommended to explore long-term outcomes and potential side effects associated with GNSRS. Conclusion:  The study's findings demonstrate that GNSRS is an effective and safe second-line treatment for patients with primary TN unresponsive to medical therapy. Significant reductions in pain intensity, as measured by the BNI pain scale, were observed following GNSRS treatment.