American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the recommended initial treatment for acute migraines without aura?

Opioids
NSAIDs
Beta-blockers
Surgical intervention

The correct answer is: NSAIDs

The recommended initial treatment for acute migraines without aura is nonsteroidal anti-inflammatory drugs (NSAIDs). This choice is based on the effectiveness of NSAIDs in managing pain associated with migraine attacks. They work by reducing inflammation and alleviating pain, which can help patients find relief from their symptoms. In the context of migraine management, NSAIDs are often favored as a first-line option due to their accessibility and broad efficacy. They are typically well-tolerated and can be used for many individuals experiencing mild to moderate migraine attacks. Additionally, NSAIDs are suitable for treating the headache itself and can be effective when taken at the onset of a migraine. Other choices, such as opioids, beta-blockers, and surgical intervention, do not serve as initial treatments for acute migraine episodes. Opioids are generally not recommended due to their potential for dependency and ineffectiveness in treating migraines compared to other available options. Beta-blockers are primarily used for migraine prophylaxis, not for acute treatment. Surgical interventions are reserved for specific and advanced cases, which makes them unsuitable as an initial treatment strategy for acute migraines.