This chapter examines central neuropathic facial pain, its mechanisms, clinical features, and diagnostic imaging approaches. Common etiologies include stroke, multiple sclerosis, tumors, trauma, and movement disorders such as Parkinson’s disease and oromandibular dystonia. It reviews characteristic pain presentations, including central dysesthesia, trigeminal neuralgia secondary to multiple sclerosis, and orofacial pain in movement disorders and bruxism. Magnetic resonance imaging (MRI) is emphasized as the preferred modality for detecting ischemic, demyelinating, or structural lesions along the trigeminal pathways. Accurate diagnosis requires comprehensive history, neurological evaluation, and targeted imaging to guide management.