International migraine treatment guidelines do not establish significant distinctions between the preventive and acute treatment of MwA and MwoA, adopting a generally unified therapeutic approach. Migraine has two main forms: migraine with aura (MwA) and migraine without aura (MwoA). 4Biologically, cortical spreading depression (CSD) is deemed a likely electrophysiological substrate of the migraine aura. Historically, we have relied on non-specific agents developed for other indications for migraine treatment, and side effects and poor tolerability have caused patient and physician frustration and delayed adequate control. Until these questions are answered, treatment at the moment cannot be usefully personalised to migraine phenotype broadly in the absence of aura-specific treatment evidence.