TN – Alternative Pharmacotherapy — SCE Neurology MCQ

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HardHeadache & Facial PainTN – Alternative PharmacotherapySCE Neurology

A 48-year-old man with trigeminal neuralgia has failed carbamazepine (hyponatraemia) and oxcarbazepine (rash). What is the next pharmacological option?

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Correct answer: B — Baclofen

When carbamazepine and oxcarbazepine are not tolerated in TN, baclofen is the recommended next-line agent per ABN and EAN guidelines. Lamotrigine is another alternative. A: Gabapentin has limited TN evidence. B: Lamotrigine is an option but baclofen is more commonly cited next-line. C: Pregabalin has limited TN evidence. D: Amitriptyline is for neuropathic pain broadly.

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