Tic douloureux is a common disease that causes excruciating pain. It is a central pain due to a lesion within the trigeminal nerve or brain stem. The majority of patients with tic douloureux are successfully treated by pharmacotherapy with phenytoin or carbamazepine. Those who fail under medical management should promptly be offered modern surgical alleviation of their pain: percutaneous radiofrequency gangliolysis or decompression of the trigeminal nerve at the brain stem (Jannetta procedure). The goal of surgical therapy should be pain relief with minimal sensory loss; the complications of surgery are usually due to denervation of the face or eye. Patients with tic douloureux should not be subjected to extraneous drug therapy or other procedures with a low likelihood of long-term success.
