Tic douloureux is an excruciatingly painful condition that primarily affects elderly people. It consists of unilateral electric shock-like facial pains triggered by non-noxious stimulation with clear-cut pain-free intervals. It should be discriminated from all other types of facial pain by the history and physical examination. Primary treatment includes anticonvulsant drugs; if these fail or side effects prevent their use, a surgical procedure is warranted. Almost every patient with tic douloureux can be relieved of his or her pain with anticonvulsant medications or surgery. Stereotactic radiosurgery, percutaneous gangliolysis and suboccipital craniectomy with microvascular decompression are the primary surgical options. The common aspects of tic douloureux and some of the rarer variations are reviewed, and treatment options are presented.