Trigeminal Neuralgia Carbamazepine — ORE Part 1 MCQ

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

ModerateOral MedicineTrigeminal Neuralgia CarbamazepineORE Part 1

A 40-year-old patient presents with intermittent facial pain triggered by light touch to the right ala of the nose. The pain is described as brief (lasting seconds), excruciating, electric shock-like, and shooting from the nose to the upper lip. Between attacks, there is no pain. MRI brain is normal. What is the first-line pharmacological treatment?

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

Reveal the answer and explanation

Correct answer: B — Carbamazepine

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

The correct answer is carbamazepine (A). The clinical presentation is classical trigeminal neuralgia (TN): brief, electric shock-like, excruciating unilateral pain triggered by innocuous stimuli (light touch), confined to a trigeminal division (V2), with pain-free intervals between attacks, and normal MRI imaging. UK guidance (NICE CG173, IPG715) and NHS specialist pathways universally designate carbamazepine as the first-line medication for TN; it blocks voltage-gated sodium channels, suppressing neuronal ectopic discharges responsible for paroxysmal pain. Oxcarbazepine is the alternative first-line agent if carbamazepine is not tolerated. Amitriptyline (B) is used for other neuropathic pain conditions but not as first-line TN monotherapy. Gabapentin (C) and pregabalin are second-line agents used as add-on therapy only. Paracetamol and ibuprofen (D, E) are ineffective for the neuropathic mechanism of TN and contraindicated as initial treatment. The diagnosis, normal imaging, and absence of continuous pain confirm uncomplicated primary TN, making carbamazepine the standard initiation.

Reference: NICE CG173 'Neuropathic pain in adults: pharmacological management in non-specialist settings' (2013, reaffirmed 2024); NICE IPG715 'Stereotactic radiosurgery for trigeminal neuralgia' (2022); Lambru G, Zakrzewska J, Matharu M. 'Trigeminal neuralgia: a practical guide.' Practical Neurology. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461413/