**Question:** All are true about treatment of migraine EXCEPT:

A. Medications should be started at the onset of migraine attack to achieve effective pain relief.
B. Tension-type headache and migraine cannot be differentiated based on symptoms alone.
C. Acute migraine treatment focuses on aborting the current attack.
D. Migraine preventive therapy is only required for patients with multiple migraine attacks per month.

**Correct Answer:** B. Tension-type headache and migraine cannot be differentiated based on symptoms alone.

**Core Concept:** Migraine is a common primary headache disorder characterized by severe, throbbing headache, often unilateral, and accompanied by various associated symptoms like nausea, vomiting, photophobia, and phonophobia. Migraine is a neurovascular event triggered by a complex interplay of genetic, environmental, and lifestyle factors.

**Why the Correct Answer is Right:** Acute migraine treatment aims to alleviate current attack symptoms and prevent future attacks. This includes medications like nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, opiates, and other analgesics. Preventive therapies are prescribed for patients with multiple migraine attacks per month or those with severe attacks not adequately managed by abortive medications.

**Why Each Wrong Option is Incorrect:**

A. While starting medications early is beneficial, it is not the sole criterion for effectiveness. Other factors, like the right medication choice, dosage, and administration time, also contribute to successful treatment.

C. Differentiating tension-type headache (TTH) and migraine is crucial as they have distinct clinical features. TTH is a common primary headache disorder characterized by bilateral, constant headache without radiation, and typically not associated with associated symptoms.

D. Migraine preventive treatments are not limited to patients with multiple attacks per month. Preventive therapies can be beneficial for patients with infrequent attacks, aiming to reduce attack frequency, severity, or duration. However, the focus of preventive treatments differs from acute treatments, targeting underlying mechanisms and comorbidities.

**Clinical Pearl:** Accurate diagnosis and appropriate treatment selection are essential for migraine management, as both conditions have distinct clinical features and treatment goals. Seek expert consultation if uncertain about the diagnosis or treatment plan.