skip to main content

Trigeminal Neuralgia – Alternative Pharmacotherapy — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardHeadache & Facial PainTrigeminal Neuralgia – Alternative PharmacotherapySCE Neurology

A 48-year-old man presents with recurrent episodes of severe lancinating pain in the left side of the face, each lasting a fraction of a second. The pain is triggered by light touch to the left cheek, eating, and cold wind. Episodes cluster over weeks, then remit for months. Neurological examination is entirely normal. He has tried and failed carbamazepine (developed hyponatraemia) and oxcarbazepine (developed a rash). What is the next pharmacological option?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Baclofen

When carbamazepine and oxcarbazepine are not tolerated or ineffective in trigeminal neuralgia, baclofen is the recommended next-line pharmacological option per ABN and EAN guidelines. It is effective for TN and has a different side-effect profile. Lamotrigine is another alternative. A: Gabapentin has limited evidence for TN specifically. B: Lamotrigine is an option but baclofen is more commonly cited as next-line. C: Pregabalin has limited evidence for TN. D: Amitriptyline is for neuropathic pain broadly but not specifically effective for TN.

Reference: ABN Trigeminal Neuralgia Guidelines; EAN TN Guidelines (2019); BNF