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Q: I have had Tic douloureux for several years. According to my neurosurgeon, I have three choices: surgery to move the nerve, surgery to remove the nerve and shooting alcohol into the nerve. Can you explain the side effects of these choices? I've been told that the affected side of my face could sag and that my eyesight might be damaged.

-- G.B., Chicago

A: Tic douloureux (pronounced "tick do-la-rue"), also called trigeminal neuralgia, is an abnormal functioning of the trigeminal nerve that carries electrical signals between part of the face and the brain.

It usually begins after age 35 and affects more women than men. It's characterized by episodes of sudden, severe, stabbing pain on one side of the face that last several seconds to minutes.

The location of the pain is characteristic of the disorder. It usually starts near one corner of the mouth, then shoots up toward the ear, eye or nostril on that side of the face. The pain is often triggered by movements such as chewing, talking, touch and even drafts.

The condition may spontaneously go away for as long as several months.

However, as the disorder progresses, the pain often becomes more frequent and relief becomes shorter. Later, a dull ache may persist between episodes of pain.

For most people, the cause is unknown, but trigeminal neuralgia is a frequent problem for people with multiple sclerosis; on rare occasions, it may result from a brain tumor.

Also, more recently, one cause was found to be an abnormal blood vessel pushing on the root of the nerve. In such cases, an operation, called a neurovascular decompression, can separate the blood vessel from the nerve and relieve the pain.

Typical pain relievers aren't usually helpful because the episodes of pain come on so quickly and last only a short time. Carbamazepine, an anti-seizure medication, is the most helpful drug for treatment.

If that drug is not effective or is not tolerated well, phenytoin or Baclofen, a drug used to treat muscle spasms, may also help either alone or combined. Also, some promising new drugs are on the horizon, including pimozide, tizanidine and topical capsaicin.

As a last resort to block the pain, the trigeminal nerve can be cut or destroyed by injecting a chemical into it or using radio frequencies or gamma rays. Gamma radiosurgery is noninvasive and seems to be successful 80 percent of the time, with only a small percentage of people getting facial paralysis. Success varies from surgeon to surgeon, so be sure to ask your neurosurgeon about his or her experience.

You do have options for treatment. Check with your neurosurgeon for recommendations and information about the risks and benefits of each as they relate to your situation.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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