Awareness, attitudes, and clinical practices related to medication-overuse headache among Italian pharmacists: results from a cross-sectional survey

Background: Medication-overuse headache (MOH) is a frequent, disabling, and largely preventable secondary headache disorder, most associated with pre-existing migraine. Since many patients rely on over-the-counter medications and experience long delays before specialist referral, community pharmacists represent key frontline professionals in the identification, counseling, and prevention of medication overuse and MOH. However, data on pharmacists’ knowledge and practices regarding migraine and MOH in Italy are still lacking. Methods: We conducted a nationwide, cross-sectional survey among Italian pharmacists and pharmacy students using a structured, self-administered questionnaire. The survey assessed demographic characteristics, knowledge of migraine and MOH, dispensing and counseling practices, screening for medication overuse, and referral behaviors. A composite scoring system, the Migraine and Medication Overuse Headache Knowledge and Awareness Scale (MMKAS; range 0–23), was developed by expert consensus to evaluate knowledge and professional behavior. Group comparisons were conducted using independent t-tests or Mann–Whitney U tests and categorical variables were analyzed using chi-square tests with standardized residual post-hoc analysis. For comparisons across more than two groups, one-way ANOVA or Kruskal–Wallis tests were applied, followed by adjusted post-hoc tests. A multivariable linear regression model was performed to identify independent predictors of total MMKAS scores. Internal consistency was evaluated using Cronbach’s α coefficient. Results: A total of 271 participants were included (mean age 40.8 ± 11.4 years; 15.5% men), representing all Italian regions. Overall migraine knowledge was generally preserved, whereas awareness of MOH thresholds, preventive strategies, and systematic screening was heterogeneous. Education level was significantly associated with MMKAS performance, while years of professional experience were not. In multivariable analysis, older age and practicing in southern regions were independently associated with higher MMKAS scores. Familiarity with newer preventive therapies, including anti-CGRP pathway drugs, was limited. Conclusions: Italian pharmacists show good general knowledge of migraine but relevant gaps in MOH prevention, systematic screening, and preventive management particularly related to novel anti-CGRP therapeutics. Targeted educational interventions, particularly during undergraduate and early postgraduate training, may strengthen pharmacists’ contribution to migraine care and MOH prevention.