Applanation tonometry is a non-invasive method of assessing the arterial blood pressure profiles in both the peripheral and systemic circulation. In this study the authors examined whether there were differences in these profiles in patients with trigeminal neuralgia. The carotid artery and derived aortic blood pressure waveforms were obtained using a pulse wave analysis system. The ratio of the pressure wave amplitude above the systolic shoulder to the total systolic blood pressure (augmentation index, AIx) was recorded. Thirty two patients with trigeminal neuralgia (16 male and 16 female) and 100 controls (50 male and 50 female) were recruited. Eleven patients had been treated by microvascular decompression, mean (SD) time from surgery 17 (24) months (range 3-86 months). For the patients with trigeminal neuralgia, the right and left carotid artery AIxs (mean (SD)) were 120.6 (21.7)% and 120.7 (19.1)% respectively. Corresponding values for the control group were 120.5 (19.3)% and 120.9 (19.5)%. The calculated AIx for the ascending aorta was 27.7 (10.1)% and 27.2 (10.5)% for the patients with trigeminal neuralgia and controls respectively. No significant differences were seen in either the right or left carotid artery (p=0.5 and p=0.6 respectively) or the derived ascending aorta (p=0.8). The results show that there does not seem to be a generalised increase in arterial stiffness in patients with trigeminal neuralgia.