MS-Related Secondary TAC Symptoms — SCE Neurology MCQ
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Correct answer: D — Refer 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