American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is an indication for considering surgical procedures in trigeminal neuralgia?

1. Failure after first-line medications

2. Severe headache

3. Neck pain

4. Presence of Horner syndrome

The correct answer is: Failure after first-line medications

In cases of trigeminal neuralgia, surgical intervention is typically considered when a patient does not respond adequately to first-line medications. First-line treatments often include anticonvulsants such as carbamazepine or oxcarbazepine; these medications aim to control the episodes of facial pain. If a patient does not achieve sufficient relief or experiences intolerable side effects, surgery may be indicated as a next step to manage the condition and significantly improve the quality of life. The other options listed do not align with the established protocols for surgical consideration in trigeminal neuralgia. Severe headaches, neck pain, and the presence of Horner syndrome are not directly related to the management of trigeminal neuralgia or do not typically warrant surgical intervention for the condition. Thus, bearing in mind the lack of treatment response with medication, the rationale for surgical options being introduced stems from the need to alleviate debilitating pain when other avenues have failed.