American Board of Family Medicine (ABFM) Practice Exam 2025 - Free ABFM Practice Questions and Study Guide

The first-line treatment for migraine headaches that have not responded to NSAIDs is oral triptans. Triptans are specifically designed to treat migraines by narrowing blood vessels in the brain and blocking pain pathways. They work by targeting specific serotonin receptors (5-HT1B and 5-HT1D), which play a significant role in the pathophysiology of migraines.

While IV metoclopramide can be effective in managing migraine symptoms, it is not considered a first-line treatment for an unresponsive migraine. Metoclopramide is primarily an antiemetic that can help alleviate nausea and vomiting associated with migraines, but it does not directly address the headache itself as effectively as triptans do.

Inhaled medication is typically not a first-line choice for migraines, and non-narcotic antiemetic drugs are more supportive in nature than curative, focusing on symptom management rather than stopping the migraine attack itself.

Overall, oral triptans represent the most effective and targeted approach for treating migraines in patients who do not find relief with over-the-counter NSAIDs.