Among 5,058 patients seen at the Mayo Clinic from 1976 through 1990 for face pain, we diagnosed trigeminal neuralgia in 2,972. Tumors were causing the face pain in 296 patients. Sex and pain distributions paralleled those in idiopathic trigeminal neuralgia; however, patients with tumors causing trigeminal neuralgia were younger than those with idiopathic pain. Meningiomas and posterior fossa tumors were the most common. Neurologic deficits developed on follow-up evaluation in 47% of the patients, often precipitating further study and eventual diagnosis of the tumor. Delay in tumor diagnosis averaged 6.3 years. CT with contrast was the most frequently used initial diagnostic radiographic technique, detecting a tumor in 40 of 43 examinations. MRI was subsequently used to confirm and better delineate the tumor in five of five cases. Carbamazepine was the most effective drug for relieving trigeminal neuralgia, but relief was usually temporary. Of the surgical treatment options, total removal of the tumor was the most effective in completely relieving tic pain. In patients at high surgical risk, however, temporarily or permanently blocking afferent impulses with radiofrequency ablation, glycerol rhizotomy, or alcohol blocks was a good alternative to craniotomy.