Tic douloureux -- literally, "painful twitch"
-- is a
syndrome in which a burning pain zips down a
nerve in the face without warning. Its causes are
generally unknown, but it's most likely to affect
people over the age of 50. It can be triggered
simply by shaving or washing your face or eating
something very hot or cold. Even a cold draft
has been known to bring it on.
Doctors frequently prescribe anticonvulsant
drugs such as Tegretol, and an experimental form
of an old drug -- baclofen -- may also prove helpful. But
when drug therapies fail or the side effects such as
nausea, dizziness, fatigue and serious bone marrow
problems can't be handled, it's time to consult a
There are a number of surgical techniques that can
relieve tic pain. But most involve trading off a degree
of facial sensitivity for a degree of relief.
The most effective and least destructive technique,
is microsurgical decompression, an operation in
which a sponge is inserted between the trigerninal
nerve, which controls facial sensation, and any
neighboring vein, artery or bone that may be
periodically putting pressure on the nerve.
If it sounds as though no one is really sure whether
or not nerve compression causes tic, that's because they aren't. But they do know that the procedure
relieves pain in 78 to 90 percent of the people who
undergo it. Unfortunately, the chance that pain will
recur - as it does with other tic procedures - is one in
And microsurgical decompression is major surgery,
which means it's only for those in good health. Tic
douloureux victims who are not in the best health,
however, have other options. Transcutaneous
electrical nerve stimulation (TENS) and radio-frequency coagulation -- a procedure that actually
involves burning the trigeminal nerve's root -- are
helpful in almost half the people on whom they're
performed. And surgical injections of glycerol can
relieve pain in 67 percent of tic douloureux victims.
Recurrent pain is not unusual with any of these
Some doctors also continue to recommend alcohol
injections or freezing, although these treatments
require expert administration and are rarely effective
for any length of time. Of course, sometimes even a
day free of pain is worth the risk. Especially when
that pain is triggered by washing your face.