"If you chose to aid her at the end of her quest line and successfully fend of her sisters, she will drop the Unalloyed Gold Needle instead and this talisman can no longer be obtained during this playthrough until a new NG+ cycle is started."
This is not totally true. You can obtain both talisman if you kill her without talk to her at the end

Lord forgive me for what I am about to do

For those of you carefully planning out Millicent's demise to get this, you can't kill her when she appears in Altus Plateau after giving her the needle, you have to then ALSO get her Prosthetic arm in Shaded Castle, give it to her, kill Godskin Apostle in Windmill Village and THEN kill her when she appears there after reloading the area.

If i were to use a multi hit spell like stars of ruin, would i be able to trigger this really fast? Do spells trigger it at all?

Nice try Fromsoft. Time to respec from DEX to INT

what have I done

Killed her in Altus region but she dropped nothing — o well

im going to do a lv 1 run but this talisman is a big NO for me.

The Fromsoftware Dev / Translator that wrote this item description really went off. Its worded so beautifully.

If you own this talisman, it means that you are an inhuman monster who never deserves to see sunlight or breath fresh air ever again.