In the case of my current project, Titan Trivia, it became apparent soon after I began writing the first questions that the game required more than just question-answer pairs. I needed to track categories, sub-categories, answer tags, difficulty ratings, and many other pieces of data that I hadn't at first considered. Writing them into a flat file wasn't an option, and using a spreadsheet wasn't that much more appealing. I probably could've used a database program of some kind, but in the I decided to write up a custom program to do the job myself. That way I could be sure it did everything I wanted it to do. I used Visual C# 2008, and ended up having almost as fun writing it as I did writing the game itself.
Anyway, I wrote the program to save to a the data to a SQL table. I'm not overly savvy with databases, and needed the questions ultimately dumped to the sqlite3 database for an Android game. Instead of doing any converting, I chose to export the table to an XML file, and in turn import the XML (on a one-time basis) into the sqlite3 database for the game.
No doubt there are other, better ways to do this, but it was fun putting it together, and I learned a lot. Now, to get to the real task at hand, and start writing trivia questions!