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Background and Importance Migraine is one of the leading causes of disability worldwide and requires effective and safe long-term treatments. Atogepant, an oral CGRP receptor antagonist, has shown clinical efficacy, but assessing its persistence, meaning the time patients remain on therapy and safety in real-world practice is essential.Aim and Objectives To determine persistence and safety of atogepant used in the prophylaxis of chronic and episodic migraine.Material and Methods Observational, retrospective study in a tertiary hospital, including patients with migraine who started treatment with atogepant between July and December 2024. Follow-up was conducted during the first 3 months of treatment. Clinical and demographic data were consulted in the computerised medical record.Treatment persistence and adherence were measured using Kaplan-Meier curves as a measure of effectiveness, and safety was analysed by recording adverse events (AEs), classified according to severity (severe or mild). Severe AEs were those that led to hospitalisation or discontinuation of treatment. Statistical analysis was performed using R software.Results 63 patients were included, with a mean age of 49 (21–73) years, of whom 56 were women (88.9%). Regarding diagnosis, 58 (92.1%) patients had chronic migraine, while 5 (7.9%) patients had episodic migraine. Regarding previous treatments, 56 (88.9%) patients had received anti-CGRP antibodies before starting atogepant.Three months after starting treatment, 40 (63.5%) patients continued to take it, while 23 (36.5%) had discontinued it. The reasons for discontinuation were 74% lack of confidence due to AEs and 26% ineffectiveness. Adherence was greater than 80% in all cases, with a mean of 97.9% (63.6%-100%).In total, 55.5% of patients experienced AEs, 17 (48.6%) patients experienced severe AEs and 18 (51.4%) patients experienced mild AEs. The most frequent AEs were digestive (nausea, vomiting, and constipation), which affected 27 (43%) patients, and neurological (headache, dizziness), reported in 6 (9.5%) patients.Conclusion and Relevance Atogepant achieved good adherence and moderate persistence for migraine prevention in this real-world cohort. Gastrointestinal EAs were frequent but mostly mild and concerns about EAs was the main reason for discontinuation. However, longer-term studies are needed to confirm sustained benefit and safety.Conflict of Interest No conflict of interest