Microneedle (MN) therapy is emerging as a promising approach for the treatment of neurological disorders, leveraging its minimally invasive nature to enhance drug delivery and monitoring capabilities. This review article comprehensively explores the advancements in microneedle technology, focusing on its applications in neurological diseases. It discusses various fabrication methods, including photolithography and 3D printing, and highlights the mechanisms of drug transfer through microneedles, such as poke and flow and poke and release. While microneedles offer significant advantages, including improved drug permeability and the ability to monitor physiological parameters, they also face challenges such as scaling difficulties, variability in drug delivery, potential for inflammation, and limitations in dosing range. The review underscores the potential of microneedles as theranostic devices, facilitating both diagnostics and therapeutic applications by enabling direct access to interstitial fluids for biomarker detection. Furthermore, the article examines the current clinical status and commercial availability of microneedle devices, aiming to provide insights for researchers and clinicians interested in this innovative delivery system. Overall, the review highlights the progress made in microneedle therapy for neurological disorders while addressing the ongoing challenges that need to be overcome for broader clinical implementation.