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a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1428:"<h3></h3> First line prophylaxis for Chronic Migraine (CM) includes tricyclics, betablockers, topiramate and candesartan as per NICE and BASH guidelines. Following three failures, onabotulinumtoxinA (2012), CGRP MAB (2022) and Gepants (2024) have been recommended by NICE. Physicians’ often make the choice based on their perception of the product. However, patients’ may be asked to make a choice following careful, honest and standard appraisal on the pros and cons of each product. We report the audit results on a large cohort of patients (N=283, F 248 M 35) seen at a tertiary headache clinic in Hull between 2022-2024 who failed three treatments and were asked to choose one based on the pros and cons of each treatment. Those offered onabotulinumtoxinA or CGRP MAB, 70% chose onabotulinumtoxinA as their preferred treatment compared to 30% for CGRP MAB. Those given three choices, 55% chose onabotulinumtoxinA, 32% CGRP MAB and 13% Gepant. OnabotulinumtoxinA was the first choice because of lack of systemic side effects, interaction with healthcare professional and relative safety in pregnancy. Weight gain and needle phobia were the main reasons against CGRP MAB and lack of real-world data and limited experience were the reasons against Gepant being the first choice. OnabotulinumtoxinA remains the first choice following three prophylactic treatment failures. fayyaz.ahmed{at}nhs.net ";}