Chronic migraine management with onabotulinumtoxinA and anti-CGRP/R monoclonal antibodies in an Italian real-world setting: update on therapeutic appropriateness and an emerging role of pharmacy

Background: Migraine is a disabling neurovascular disorder that may evolve from episodic to chronic forms, often complicated by medication-overuse headache (MOH). It generates substantial healthcare expenditures and indirect societal costs. Pharmacological constraints and resistance to acute therapies contribute to the development of MOH and increase the need for preventive treatments such as onabotulinumtoxin A (BoNT/A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway. Objective: This pharmacoepidemiology retrospective study aimed to evaluate real-world prescription patterns of BoNT/A and anti-CGRP/R mAbs in an Italian regional setting and to compare current data (2023–2024) with previously observed patterns (2020–2022) before the integration of pharmacists as outpost in migraine man-agement. Methods: Anonymized data were obtained from the regional drug reimbursement and prescription database. Results: A total of 9,012 and 9,705 prescriptions were recorded in 2023 and 2024, respectively, indicating an increasing trend in the use of innovative preventive therapies. A gradual increase in the use of eptinezumab and BoNT/A appears to be associated with regional organizational measures aimed at improving access to care, adherence to clinical guidelines, and integrated management across healthcare levels. Conclusion: Therapeutic appropriateness is far from reaching the gold standard and an increasing role of pharmacists could improve clinical outcomes.