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Background and Importance Patient-reported outcome measures (PROMs) are essential to evaluate the real-world impact of preventive therapies in migraine. Minimal clinically important difference (MCID) thresholds allow the identification of meaningful improvements, yet their longitudinal evolution in clinical practice remains underexplored.Aim and Objectives To assess the proportion of patients achieving clinically meaningful improvements in HIT-6 (≥3 points) and MIDAS (≥4.5 points) over 24 months in a real-world migraine cohort, and to characterise patient demographics and treatment exposure.Material and Methods Prospective observational stud in patients with preventive treatments targeting the CGRP pathway were included . PROMs were collected remotely via a telepharmacy platform at baseline and follow-up (1, 3, 6, 12 and 24 months). . Responder analysis was conducted in patients with paired baseline–follow-up data. Responders were defined as ≥3-point reduction in HIT-6 or ≥4.5-point reduction in MIDAS. Proportions of responders were calculated at each timepoint; Chi-squared tests assessed differences across visits.Results A cohort of 244 patients with migraine from 10 centres was followed Mean age was 45.2 years (SD 12.3; range 18.0–75.0; IQR 37.0–54.0); 82.1% were women. 55% of ePROMs were completed.Patients received the following CGRP pathway-targeted preventive treatments: 32.4% galcanezumab, 28.1% erenumab, 24.3% fremanezumab, 8.2% atogepant, 2.5% eptinezumab, 4.5% others.The overall response rate to ePROMs was 54.8%.HIT-6 responders: 1m 54.8% , 3m 63.6%, 6m 70.7% , 12m 66.7% , 24m 70.4%.MIDAS responders: 1m 62.1% , 3m 66.0% (68/103), 6m 71.0% , 12m 68.3% , 24m 68.0%.Responder rates remained stable over time, with no statistically significant differences across visits (HIT-6: χ2=6.36, p=0.174; MIDAS: χ2=6.54, p=0.162).Conclusion and Relevance In this real-world migraine cohort of patients, preventive therapies targeting the CGRP pathway led to sustained clinical improvements, with ~55–70% of patients achieving MCID in HIT-6 and MIDAS at all follow-up points up to 24 months. These findings support the effectiveness and durability of anti-CGRP therapies in routine clinical practice and underline the value of PROM-based longitudinal monitoring through telepharmacy platforms.Conflict of Interest No conflict of interest