Aims The aim of this study was to evaluate and compare percutaneous distal pulsed radiofrequency (DPRF) and proximal pulsed radiofrequency (PPRF) for the trigeminal nerve in the management of trigeminal neuralgia (TN). Patients and methods We conducted a prospective clinical trial including 20 patients with recent TN (3–6 months). The patients were randomized into two groups: DPRF (n=10) and PPRF (n=10). Patients were clinically followed up for 1 year and pain intensity was assessed at 3, 6, 9, and 12 months after the procedure using the visual analog scale (VAS). Results The percentages of patients with satisfactory pain relief (50–80% pain relief) were 30% at 3 months, 40% at 6 months, and 40% at 12 months in DPRF group. However, in PPRF group, the percentages of patients who showed excellent pain relief (≥80% pain relief) at 3, 6, and 12 months were 50, 50, and 40%, respectively, whereas the percentages of patients with satisfactory pain relief (50–80% pain relief) at 3, 6, and 12 months were 40, 30, and 60%, respectively. Comparing theVAS score at 1, 3, 6, and 12 months did not show any significant difference between the two groups. In both groups, there was a significant decrease in VAS score after 1, 3, 6, 9, and 12 months compared with the preprocedure score (P<0.001). Conclusion PRF treatment is a safe, effective, well-controlled procedure for the treatment of TN. There was no significant difference between DPRF and PPRF procedures. DPRF is a simple, safe, and effective procedure before the attempt to do the intracranial procedure.