Objective: To analyze the degree of psychological distress among elderly patients with recurrent trigeminal neuralgia and its influencing factors. Methods: A single-center cross-sectional study was conducted on 126 elderly patients with recurrent trigeminal neuralgia who visited the Pain Department of our hospital from March 2022 to April 2024. Logistic regression analysis was employed to evaluate the factors influencing psychological distress, based on general patient data, the Distress Thermometer (DT), the Perceived Social Support from Family Scale (PSS-Fa), and the Pittsburgh Sleep Quality Index (PSQI). Results: Among the 126 elderly patients with recurrent trigeminal neuralgia, those with a DT score ≥ 4 (72 patients, 57.14%) were more prevalent than those with a DT score < 4 (54 patients, 42.86%). The average DT score for all patients was 4.35 ± 1.72. Patients in the DT score ≥ 4 group were older than those in the DT score < 4 group (t = 4.207, P = 0.000), had lower PSS-Fa scores (t = 5.925, P = 0.000), and had higher PSQI scores (t = 17.858, P = 0.000). There were no statistically significant differences in gender, marital status, residence area, education level, disease type, or pain location (all P > 0.05). Older age and poor sleep quality were identified as independent risk factors for psychological distress in elderly patients with recurrent trigeminal neuralgia (OR = 1.258, OR = 1.713, both P < 0.05), while higher levels of family support were identified as a protective factor (OR = 0.581, P = 0.025). Conclusion: Elderly patients with recurrent trigeminal neuralgia experience psychological distress, and the degree of severity depends on age, quality of sleep, and level of family support.