American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for trigeminal neuralgia?

1. Carbamazepine

2. Oxcarbazepine

3. Gabapentin

4. Lamotrigine

The correct answer is: Carbamazepine

Carbamazepine is recognized as the first-line treatment for trigeminal neuralgia because of its established efficacy in reducing the frequency and severity of the painful episodes associated with this condition. It acts by stabilizing the neuronal membrane and inhibiting the abnormal firing of the trigeminal nerve, which is responsible for the pain. Numerous studies and clinical guidelines support its use due to its significant analgesic effects compared to other options. While other medications such as oxcarbazepine, gabapentin, and lamotrigine can also be effective in managing trigeminal neuralgia, they are generally considered as second-line treatments or alternative options in cases where carbamazepine is ineffective or not tolerated. Oxcarbazepine, for example, has a similar mechanism to carbamazepine but may come with fewer side effects. Gabapentin is often used for neuropathic pain but has a different pharmacological profile and may not be as effective specifically for trigeminal neuralgia compared to carbamazepine. Lamotrigine, while beneficial in certain contexts, is not as commonly used as first-line therapy for this specific type of pain.