American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for a typical migraine not relieved by oral medications?

1. Oral triptans

2. IV metoclopramide

3. Intranasal sumatriptan

4. Topical analgesics

The correct answer is: IV metoclopramide

In cases of migraines that are not relieved by oral medications, intravenous (IV) metoclopramide is an effective treatment option. Metoclopramide acts as an antiemetic and also has prokinetic properties. It helps in alleviating nausea and vomiting often associated with migraines, and it can enhance gastric emptying, which may help in the absorption of other medications if taken after. When oral medications are ineffective, using IV metoclopramide can provide rapid relief for patients. The administration via IV allows for better and quicker absorption compared to oral routes. This can be especially beneficial in an emergency setting where a patient requires prompt alleviation of migraine symptoms. Other routes of administration, such as intranasal triptans, may also be effective, but metoclopramide directly addresses both the migraine headache and associated nausea, making it a suitable option for patients who are unable to take oral medications.