American Board of Internal Medicine (ABIM) Certification Practice Exam

In the context of migraine, what is the recommended approach for emesis control if oral medications fail?

1. Subcutaneous injections

2. Intravenous hydration

3. IV metoclopramide

4. Topical antiemetics

The correct answer is: IV metoclopramide

The recommended approach for emesis control when oral medications fail in the context of migraine is to use intravenous metoclopramide. Metoclopramide is an antiemetic that works by stimulating gastric motility and accelerating gastric emptying, which can be particularly useful in patients experiencing nausea and vomiting associated with migraines. When oral medications are ineffective, intravenous administration allows for more immediate and reliable absorption and therapeutic effect, making it a preferred choice in acute migraine treatment settings. Furthermore, metoclopramide also has analgesic properties that may help in alleviating migraine symptoms, improving both nausea and headache concurrently. In contrast, while subcutaneous injections might provide alternative medication delivery routes, they do not specifically target emesis as effectively as IV metoclopramide does. Intravenous hydration may help in cases of dehydration but does not address nausea and vomiting as a primary concern. Topical antiemetics are generally less effective for acute emesis in migraine since their systemic absorption and onset of action may not be rapid enough to manage acute symptoms effectively. Therefore, IV metoclopramide stands out as the most appropriate choice for emesis control in this scenario.