Trigeminal neuralgia (tic douloureux).

Trigeminal neuralgia is not common, but is a debilitating pain syndrome. After the diagnosis is established, a stepwise approach to treatment is recommended. Carbamazepine is the drug of choice. When carbamazepine fails to relieve pain, baclofen and then phenytoin are used. A number of second-line drugs, such as clonazepam, divalproex sodium, chlorphenesine carbamate, and pimozide can also be tried. A large number of patients will respond to one or another drug or to a combination of two drugs. When medical treatment fails, several surgical procedures have been found to be effective. Percutaneous radiofrequency gangliolysis is the most widely used procedure with a high success rate. All surgical procedures must be performed by an experienced physician in order to achieve the lowest possible rate of serious complications.