Background: Trigeminal neuralgia is a chronic, debilitating neuropathic pain condition characterized by severe facial pain in the distribution of one or more branches of the trigeminal nerve. Accurate identification of neurovascular conflict or other structural abnormalities is essential for diagnosis and treatment planning. Advanced MRI techniques, especially the 3D-Constructive Interference in Steady State (3D-CISS) sequence, offer high-resolution imaging of the cranial nerves and adjacent vascular structures, improving the diagnostic accuracy in cases of trigeminal neuralgia. Aim: To assess and compare the morphologic and hemodynamic parameters of the carotid arteries using Doppler ultrasonography in smokers and non-smokers. Materials and Methods: This was a prospective observational study conducted over a one-year period from January 2023 to December 2023 at a tertiary care hospital. A total of 50 patients with clinically diagnosed trigeminal neuralgia were included. All patients underwent MRI brain with dedicated 3D-CISS sequences to assess the trigeminal nerve for the presence of neurovascular compression or other pathologies. Results: Out of the 50 patients evaluated, neurovascular conflict was detected in 38 cases (76) using the 3D-CISS sequence. The superior cerebellar artery was the most commonly implicated vessel, seen in 29 of these cases. Trigeminal nerve root distortion or atrophy was also appreciable in 12 patients. In 12 patients (24), no vascular contact was observed, and the MRI findings were within normal limits. Conclusion: The 3D-CISS MRI sequence is a highly sensitive non-invasive imaging modality for evaluating patients with trigeminal neuralgia. It offers precise anatomical detail of the trigeminal nerve and its surrounding vasculature, making it invaluable in detecting neurovascular conflicts and aiding in treatment planning. © 2025 Elsevier B.V., All rights reserved.