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Background and Importance The commercialisation of gepants for the treatment of chronic migraine (CM) and high-frequency episodic migraine (HFEM) has allowed the therapeutic arsenal for this pathology to be increased. However, doubts arise as to whether their effectiveness will be the same in naive patients compared to patients previously treated with anti-CGRP monoclonal antibodies.Aim and Objectives To compare the effectiveness and safety of gepants (atogepant and rimegepant) in patients diagnosed with CM and HFEM naive versus those previously treated with anti-CGRP monoclonal antibodies.Material and Methods Retrospective observational study on patients treated with gepants, comparing naive patients to those pre-treated with anti-CGRP antibodies. The main effectiveness variables included changes in the mean monthly migraine days (MMD) and the percentages of patients achieving ≥50% or 30-49% reduction in MMD after at least 12 weeks of treatment. Safety variables were treatment discontinuation rates and the main adverse events reported in patients who received at least one dose of gepant. Clinical and treatment data were collected from electronic health records (Selene ) and the external prescription module (Farmatools). Statistical analysis involved descriptive measures and t-tests to evaluate differences in RStudio (v. 2023.09.1).Results Between March 2024 and June 2025, 192 patients were selected. The 92.7% were women (178/192) and the mean age was 47 years (SD=12.6). Effectiveness was evaluated in 181 patients: 72.4% (131/181) naive and 27.6% (50/181) pre-treated, with 13 and 17 baseline MMD, respectively. After 12 weeks, MMD decreased to 7 for naive and 8 for pre-treated patients, with a non-statistically significant difference of 1 day (p=0.42). In the naive-group MMD≥50% was 58.8% (77/131) and MMD30-49% was 14.5% (19/131). Pre-treated-group MMD≥50% was 64% (32/50) and MMD30-49% was 10% (5/50). Safety analysis included 192 patients. The 3.7% (5/135) naive and 15.8% (9/57) pre-treated patients discontinued the treatment. The reasons were: lack of response (60% (3/5) naive; 88.9% (8/9) pre-treated), adverse effects (40% (2/5) naive; 66.7% ( 6/9) pre-treated) and both reasons (55.6% (5/9) pre-treated). The most common side effects were constipation, nausea, and weight loss.Conclusion and Relevance Gepants used in the treatment of migraine appear to reduce migraine days similarly in naive and pre-treated patients. Regarding safety, both groups demonstrate an adequate safety profile, despite a higher rate of treatment discontinuation observed in pretreated patients.Conflict of Interest No conflict of interest