Neurocritical care unit (NCCU) population requires a targeted approach to sedation and analgesia. Sedo-analgesia facilitates the management of acute neurological insult by positively affecting the intracranial hemodynamics, in addition to improving conditions for intubation and mechanical ventilation (MV). The significance of sedation and analgesia is recognized by widely adopted recommendations. However, many randomized trials evaluating the optimal sedation management have excluded critically ill neurological patients; hence, controversies exist in this area. Here, we will review the controversies in sedation practices, highlighting the rationale for the use of sedo-analgesia, the advantages and disadvantages of various agents, clinical pitfalls, evidence-based practices, and emerging evidence, which will facilitate clinical decision-making in neurocritical care.