{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:45:13Z","timestamp":1782913513724,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>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\u20132024) with previously observed patterns (2020\u20132022) 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.<\/jats:p>","DOI":"10.3389\/fphar.2026.1868002","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:51:38Z","timestamp":1782910298000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"17","author":[{"given":"Damiana","family":"Scuteri","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University \u201cMagna Gr\u04d5cia\u201dof Catanzaro","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Diana","family":"Naturale","sequence":"additional","affiliation":[{"name":"Directorate-General for Animal Health, Ministry of Health","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Pagliaro","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Preclinical and Translational Pharmacology, Health and Nutritional Sciences, University of Calabria, Rende","place":["Cosenza, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Brescia","sequence":"additional","affiliation":[{"name":"Pharmacy Unit, AOU Renato Dulbecco","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adele Emanuela","family":"De Francesco","sequence":"additional","affiliation":[{"name":"Pharmacy Unit, AOU Renato Dulbecco","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary W.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, Dublin City University","place":["Dublin, Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacinto","family":"Bagetta","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Preclinical and Translational Pharmacology, Health and Nutritional Sciences, University of Calabria, Rende","place":["Cosenza, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Tiziana","family":"Corasaniti","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University \u201cMagna Gr\u04d5cia\u201dof Catanzaro","place":["Catanzaro, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s10194-025-02021-3","article-title":"The role of community pharmacists in managing common headache disorders, and their integration within structured headache services: position statement on behalf of the European headache federation (EHF) and lifting the Burden (LTB: the Global campaign against headache), with the formal endorsement of the international pharmaceutical Federation","volume":"26","author":"BaniHani","year":"2025","journal-title":"J. Headache Pain"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1177\/0333102415570497","article-title":"Triptans use and overuse: a pharmacoepidemiology study from the French health insurance system database covering 4.1 million people","volume":"35","author":"Braunstein","year":"2015","journal-title":"Cephalalgia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1056\/NEJMcp1605502","article-title":"Migraine","volume":"377","author":"Charles","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s12889-024-21244-8","article-title":"The epidemiology and unmet need of migraine in five European countries: results from the national health and wellness survey","volume":"25","author":"Coppola","year":"2025","journal-title":"BMC Public Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"332","DOI":"10.3390\/toxins15050332","article-title":"Safety of onabotulinumtoxin A in chronic migraine: a systematic review and meta-analysis of randomized clinical trials","volume":"15","author":"Corasaniti","year":"2023","journal-title":"Toxins (Basel)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1177\/0333102414550419","article-title":"Triptan use in Italy: insights from administrative databases","volume":"35","author":"Da Cas","year":"2015","journal-title":"Cephalalgia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1016\/s1474-4422(18)30322-3","article-title":"Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global burden of disease study 2016","volume":"17","author":"Gbd 2016 Headache Collaborators","year":"2018","journal-title":"Lancet Neurol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1128\/iai.64.5.1589-1594.1996","article-title":"Molecular composition of Clostridium botulinum type A progenitor toxins","volume":"64","author":"Inoue","year":"1996","journal-title":"Infect. Immun."},{"key":"B9","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s10194-018-0839-1","article-title":"Poor medical care for people with migraine in Europe - evidence from the Eurolight study","volume":"19","author":"Katsarava","year":"2018","journal-title":"J. Headache Pain"},{"key":"B10","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.1468-2982.2004.00851.x","article-title":"FRAMIG 2000: medical and therapeutic management of migraine in France","volume":"25","author":"Lucas","year":"2005","journal-title":"Cephalalgia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1517\/17425255.2015.982089","article-title":"The therapeutic armamentarium in migraine is quite elderly","volume":"11","author":"Martelletti","year":"2015","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/14656566.2018.1549223","article-title":"Advances in orally administered pharmacotherapy for the treatment of migraine","volume":"20","author":"Martelletti","year":"2019","journal-title":"Expert Opin. Pharmacother."},{"key":"B13","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s10194-019-1027-7","article-title":"A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years","volume":"20","author":"Piccinni","year":"2019","journal-title":"J. Headache Pain"},{"key":"B14","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1177\/03331024211053571","article-title":"Erenumab versus topiramate for the prevention of migraine - a randomised, double-blind, active-controlled phase 4 trial","volume":"42","author":"Reuter","year":"2022","journal-title":"Cephalalgia"},{"key":"B15","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s10194-022-01431-x","article-title":"European headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention \u2013 2022 update","volume":"23","author":"Sacco","year":"2022","journal-title":"J. Headache Pain"},{"key":"B16","doi-asserted-by":"publisher","first-page":"924","DOI":"10.3390\/ph14090924","article-title":"Progress in the treatment of migraine attacks: from traditional approaches to eptinezumab","volume":"14","author":"Scuteri","year":"2021","journal-title":"Pharm. (Basel)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1358\/dot.2019.55.11.3069864","article-title":"Eptinezumab for the treatment of migraine","volume":"55","author":"Scuteri","year":"2019","journal-title":"Drugs Today (Barc)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.4103\/1673-5374.272630","article-title":"Pattern of triptans use: a retrospective prescription study in Calabria, Italy","volume":"15","author":"Scuteri","year":"2020","journal-title":"Neural Regen. Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3390\/toxins14080529","article-title":"Pooled analysis of real-world evidence supports Anti-CGRP mAbs and OnabotulinumtoxinA combined trial in chronic migraine","volume":"14","author":"Scuteri","year":"2022","journal-title":"Toxins (Basel)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s10194-025-02240-8","article-title":"Epigenetics in migraine: the junior editorial board members' vision","volume":"27","author":"Scuteri","year":"","journal-title":"J. Headache Pain"},{"key":"B21","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1080\/17581869.2025.2487413","article-title":"Efficacy and safety of mAbs anti-CGRP\/CGRP R (eptinezumab and erenumab) or atogepant in combination with onabotulinumtoxinA in refractory chronic migraine: a clinical trial protocol","volume":"15","author":"Scuteri","year":"","journal-title":"Pain Manag."},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s10194-018-0864-0","article-title":"Use and overuse of triptans in Austria - a survey based on nationwide healthcare claims data","volume":"19","author":"Zebenholzer","year":"2018","journal-title":"J. Headache Pain"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1868002\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:51:38Z","timestamp":1782910298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1868002\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":22,"alternative-id":["10.3389\/fphar.2026.1868002"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1868002","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1868002"}}