The practical limits of high-quality magnetic resonance imaging for the diagnosis and classification of trigeminal neuralgia

•Interrater reliability about neurovascular compression on clinical imaging for TN is moderate when blinded.•Higher agreement is achieved with extreme cases while most cases remain ambiguous.•When controls are included, blinded assessment of neurovascular compression did not improve prediction of nerves with TN.•High resolution and contrast MRI of the trigeminal nerves does not predict diagnosis of TN and should not limit treatments.