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Background and Importance Migraine causes sensory and digestive symptoms; preventive treatment reduces attack frequency and severity, improving patients’ overall quality of life.Aim and Objectives To evaluate the effectiveness of anti-CGRP therapies as prophylactic treatment in patients with chronic and high-frequency episodic migraine following treatment switching.Material and Methods A descriptive, observational and retrospective study was conducted including all patients with chronic or high-frequency episodic migraine who underwent treatment switching with different anti-CGRP therapies at our centre between August 2020 and December 2024.Data obtained from electronic medical records included age, sex, migraine type, days of migraine per month (DMM) at baseline and at 3 and 6 months, treatment and adverse drug reactions (ADR). Patients were classified as non-responders (NR), moderate responders (MR, DMM reduction ≥30%), or good responders (GR, DMM reduction ≥50%). Statistical analysis used measures of central tendency and dispersion for quantitative variables and absolute frequencies for qualitative variables.Results Forty-one patients (89% women) with chronic (93%) and episodic (7%) migraine were included, with a mean age of 44 [range 23–62] years. All started treatment with galcanezumab and after evaluating the effectiveness of the last cycle received, the first switch was to erenumab (except in one patient) and the second to eptinezumab. The main reason for switching was the ineffectiveness of the previous treatment, except for ADR in three patients. The results are summarised in table 1.Abstract 4CPS-254 Table 1Effectiveness of anti-CGRP therapies following treatment switching Anti-CGRP Evaluated patients Evaluation time (months) GR (%) MR (%) NR (%) Not evaluated Galcanezumab 41 3 12% 10% 68% 10% 6 7% 5% 51% 37% Erenumab 40 3 13% 18% 64% 5% 6 15% 23% 35% 27% Eptinezumab 24 3 17% 50% 25% 29% 6 17% 37% 17% 29% ADR were recorded in 25 patients, the main one being constipation (25%), most frequent for erenumab (31%), followed by galcanezumab (27%) and eptinezumab (15%).Conclusion and Relevance Treatment effectiveness was observed to progressively decrease when switching from one drug to another, especially in patients undergoing a third treatment. Additional, longer-term studies are needed to determine the optimal sequence of therapeutic switching to maximise effectiveness in these patients.Conflict of Interest No conflict of interest