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Background and Importance Rimegepant is a calcitonin gene-related peptide receptor antagonist indicated for migraine prophylaxis in adults with at least four migraine days per month.Aim and Objectives This study aimed to evaluate the real-world effectiveness and safety of rimegepant in a tertiary-care hospital.Material and Methods We conducted a retrospective observational study of patients treated with rimegepant between January 2024 and July 2025. Demographic variables (sex, age), treatment regimen, duration, migraine attacks before/after treatment and previous prophylactic drugs were recorded. To assess the impact of migraine, the Headache Impact Test (HIT-6), the Visual Analogue Scale (VAS), and the Patient Global Impression of Change (PGIC) were used. Adverse events were also documented. Statistical analysis was performed using R 4.4.1 and Wilcoxon test.Results A total of 46 patients were included, 80.4% female, with a mean age of 44.0±13.8 years. Chronic migraine was present in 23.9% and high-frequency episodic migraine (HFEM) in 76.1%. Patients had received a median of 5.0 (4–7) prior prophylactic drugs, among which the most common were amitriptyline (89.1%), flunarizine (78.3%), topiramate (76.1%), and zonisamide (50.0%). Prior biologic therapy included three agents in 13.0% of patients, two in 8.7%, and one in 10.9%. At baseline, the mean HIT-6 score was 62.0±3.7 and the median VAS was 8 (7–9). Median treatment duration with rimegepant was 8.0 (4.6–13.6) months at the standard prophylactic dose of 75 mg every 48 hours.The baseline median number of migraine attacks was 10 (8–11), which significantly decreased to four (3–8) with treatment (p<0.001). Baseline PGIC was four (4–6), decreasing significantly to three (2–4) (p<0.01). Treatment adherence was high (89.1%).Adverse events occurred in 34.8% of patients, most commonly asthenia (25.0%), dyspepsia (18.8%), and nausea (12.5%). Discontinuation was reported in 23.9% (N=10) of patients, five of them due to adverse events.Conclusion and Relevance Rimegepant appears to be an effective and safe option of treatment. In this study, it was associated with a reduction in migraine frequency and an improvement in patient-reported outcomes. Although a substantial proportion of patients experienced adverse events, these were mild and easily managed in most cases, with a safety profile consistent with that observed in clinical trials. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings.Conflict of Interest No conflict of interest