Trigeminal neuralgia is a rare condition characterized by brief, recurrent episodes of severe, unilateral, sharp pain limited to the sensory distribution of the trigeminal nerve. Neurovascular compression in the cisternal segment of the trigeminal nerve is considered the most common cause. Here, we present the case of an elderly man who had a two-year history of electric shock-like pain involving the right side of the face and associated facial spasms. The patient had a long-standing history of hypertension, diabetes mellitus, dyslipidemia, and previous coronary artery bypass graft surgery. The patient underwent magnetic resonance imaging, which revealed abnormal dilatation and tortuosity of the vertebral and basilar arteries, which resulted in compression of the facial and trigeminal nerves along with brainstem compression. Such findings were consistent with the diagnosis of vertebrobasilar dolichoectasia. The patient was given medical treatment in the form of carbamazepine, which resulted in satisfactory improvement in his symptoms. Vertebrobasilar dolichoectasia is a rare cause of neurovascular compression of the trigeminal and facial nerves that can lead to trigeminal neuralgia and facial hemispasm. Medical management should be attempted first, particularly in those patients who are not candidates for surgical interventions.