American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred in-patient treatment for status migrainosus?

1. Oral glucocorticoids

2. Intravenous dihydroergotamine

3. Oral sumatriptan

4. Intravenous fluids

The correct answer is: Intravenous dihydroergotamine

The preferred in-patient treatment for status migrainosus is intravenous dihydroergotamine. This medication is specifically effective for treating severe and prolonged migraine attacks that do not respond to standard oral treatments. Dihydroergotamine works by acting on serotonin receptors and causing vasoconstriction of the cranial blood vessels, which alleviates the headache. In cases of status migrainosus, where a migraine has lasted for more than 72 hours, prompt and effective treatment is essential to avoid complications and improve patient comfort. Intravenous administration allows for faster absorption and onset of action compared to oral medications, which can be crucial when patients are experiencing severe nausea or vomiting that prevents oral intake. This treatment option is generally preferred because it not only addresses pain relief but also reduces the duration and severity of the migraine episode. Other treatments, while potentially useful in certain situations, do not offer the same efficacy for severe and persistent migraine attacks, making intravenous dihydroergotamine the superior choice in an inpatient setting.