Neurological symptoms are a frequent source of diagnostic uncertainty in primary care, ranging from common presentations such as migraine and peripheral neuropathy to more unusual conditions including multiple sclerosis, trigeminal neuralgia and motor neurone disease.
This case-based module explores five such challenging scenarios that clinicians may encounter in everyday practice, and discusses evidence-based approaches to their assessment, investigation and management, while highlighting current NICE recommendations and practical considerations.
Topics include migraine management in patients with comorbidities, the assessment of trigeminal neuralgia and exclusion of secondary causes, distinguishing true MS relapse from pseudorelapse, investigating peripheral neuropathy in older adults, and assessing patients concerned about motor neurone disease.
Learning objectives
This module will support GPs to:
- Select appropriate acute and preventive treatment strategies for migraine, including management options when beta blockers are contraindicated and considerations around menstrual migraine.
- Recognise the clinical features of trigeminal neuralgia, identify red flags for secondary causes such as multiple sclerosis, and understand appropriate investigation and referral pathways.
- Differentiate between a true relapse and a pseudorelapse in multiple sclerosis, and apply current guidance on the use of corticosteroids in relapse management.
- Assess and investigate peripheral neuropathy in older adults, including identification of common reversible causes and appropriate use of referral pathways.
- Evaluate patients presenting with muscle cramps and fasciculations, distinguishing benign causes from features suggestive of motor neurone disease and providing appropriate reassurance, investigation and safety-netting.
Reviewed by: Dr Keith Hopcroft, GP and Pulse Clinical advisor
Date published: 03.07.2026
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