ABIM Exam Review Practice Question of the Week: 35-year-old female with headaches for several months

This week’s sample ABIM Exam Review Question comes directly from the Knowmedge QVault which covers topics listed on the ABIM Board Exam blueprint




35-year-old female presents with headaches for several months. She says the headaches occur daily and last for a few hours. They are usually located in the frontal region and are dull and aching in nature. Currently she says the pain is 3/10 in intensity. The headaches are worsened by bright light and loud sounds and made better when she lies in a quiet and dark room. She admits to drinking a lot of caffeine and eating chocolate daily. She sees spots sometimes in front of her eyes. She also sometimes has nausea without vomiting. She denies blurry vision, slurred speech, muscle weakness, double vision or numbness/tingling. Which medication is not used as prophylaxis for the likely etiology of her headaches?


A. Topiramate

B. Verapamil

C. Propranolol

D. Amitriptyline

E. Sumatriptan





After identifying the patient’s diagnosis, we need to determine which medication will serve as prophylaxis against the condition. Her history of headaches that improve when lying in a quiet, dark room and are made worse with bright lights, loud sounds and caffeine consumption suggests migraine headaches. Interestingly, caffeine can also be an alleviating factor in some individuals.

Choice A (Topiramate), calcium-channel blockers like Choice B (Verapamil), beta blockers like Choice C (Propranolol), and tricyclic antidepressants like Choice D (Amitriptyline) can all be used as prophylaxis to prevent migraine headaches from occurring and should be taken on a daily basis. Verapamil is indicated as a second-line prophylactic agent, particularly when beta blockers such as propranolol cannot be tolerated.

Choice E (Sumatriptan) is used only when the patient is actually experiencing a migraine headache. Therefore, it is not a medication used for prophylaxis. Furthermore, sumatriptan is contraindicated in patients with coronary artery disease. In those patients, an alternative is the combination of acetaminophen, aspirin and caffeine.


You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.

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