Current treatment of tic douloureux.

Tic douloureux is an exquisitely agonizing facial pain syndrome that is commonly first identified in the dentist's office. It is caused by a lesion in the brain stem or the trigeminal nerve root entry zone (NEZ), and in the vast majority of patients it can be effectively treated, one it is correctly diagnosed. Pharmacologic therapy is successful in most patients. Phenytoin and carbamazepine are the most effective drugs at this time. Modern surgical methods are available for those who fail to respond to pharmacologic management. Percutaneous radiofrequency gangliolysis and microsurgical decompression of the trigeminal nerve root entry zone at the brain stem (Jannetta procedure) are the two procedures that have become particularly worthwhile in relieving the pain without producing a neurologic deficit.