The APPRAISE trial compared erenumab with nonspecific oral migraine preventives (OMPMs) in patients with episodic migraine (EM) who had previously failed 1 or 2 preventive treatments. The study found that erenumab was significantly more effective, better tolerated, and led to better adherence compared to OMPMs. At 12 months, 56.2% of patients on erenumab achieved a 50% or greater reduction in monthly migraine days (MMDs), compared to 16.8% on OMPMs. Erenumab also showed a higher responder rate on the Patients' Global Impression of Change (PGIC) scale, with 76.0% of patients reporting improvement versus 18.8% on OMPMs. Erenumab also resulted in a greater reduction in cumulative average MMDs (-4.32 days) compared to OMPMs (-2.65 days). Fewer patients on erenumab switched medications or discontinued treatment due to adverse events. No new safety signals were identified. The study highlights that earlier use of erenumab provides sustained efficacy, safety, and adherence, making it a better option than OMPMs for patients with EM who have failed previous treatments. The findings support the use of erenumab as a first-line treatment for migraine prevention.The APPRAISE trial compared erenumab with nonspecific oral migraine preventives (OMPMs) in patients with episodic migraine (EM) who had previously failed 1 or 2 preventive treatments. The study found that erenumab was significantly more effective, better tolerated, and led to better adherence compared to OMPMs. At 12 months, 56.2% of patients on erenumab achieved a 50% or greater reduction in monthly migraine days (MMDs), compared to 16.8% on OMPMs. Erenumab also showed a higher responder rate on the Patients' Global Impression of Change (PGIC) scale, with 76.0% of patients reporting improvement versus 18.8% on OMPMs. Erenumab also resulted in a greater reduction in cumulative average MMDs (-4.32 days) compared to OMPMs (-2.65 days). Fewer patients on erenumab switched medications or discontinued treatment due to adverse events. No new safety signals were identified. The study highlights that earlier use of erenumab provides sustained efficacy, safety, and adherence, making it a better option than OMPMs for patients with EM who have failed previous treatments. The findings support the use of erenumab as a first-line treatment for migraine prevention.