Several studies suggest that the abnormalities of energy metabolism could be more pronounced in migraine with complex neurological aura. The phosphocreatine/phosphate (PCr/Pi) ratio, a marker of the brain’s energy reserve, differed significantly between patients with different aura phenotypes and was lowest in those with more complex auras [58]. In a 1H-MR-spectroscopy study [20] MA+ patients had a significant increase of lactate in the visual cortex during sustained visual stimulation, while this was not the case in HV and MA patients. Variants in the mitochondrial DNA, such as those that distinguish responders from non-responders to preventive anti-migraine treatment with riboflavin [59], could play a role in the metabolic differences between aura phenotypes.