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MS-Related Secondary TAC Symptoms — SCE Neurology MCQ

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HardHeadache & Facial PainMS-Related Secondary TAC SymptomsSCE Neurology

A patient with multiple sclerosis has classical trigeminal neuralgia. Carbamazepine is contraindicated because of a serious previous hypersensitivity reaction. Which next step best follows the NICE trigeminal-neuralgia pathway?

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

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Correct answer: DRefer to a specialist facial-pain service before selecting another medicine or intervention

NICE recommends carbamazepine as the initial treatment for trigeminal neuralgia, but advises seeking specialist advice when it is ineffective, not tolerated or contraindicated. The guideline does not instruct clinicians to substitute the generic neuropathic-pain sequence automatically, because alternative medicines and procedural options require individual assessment. Sumatriptan is not standard trigeminal-neuralgia treatment, corticosteroids are not routine attack prevention, and a serious hypersensitivity history rules out casual rechallenge.

Reference: NICE CG173: Neuropathic pain — trigeminal neuralgia recommendations. https://www.nice.org.uk/guidance/cg173/chapter/Recommendations