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Since the high burden of chronic migraine (CM), it is challenging to identify the best prevention treatment. Based on the preclinical evidences about the different therapeutic targets of OnabotulinumtoxinA (BT-A), acting on C-fibers and anti-CGRP monoclonal antibodies (mAbs) acting on Aδ-fibers, the rationale of using as alternative or combining therapies has been hypothesized. Until now, the association of BT-A and mAbs has been poorly investigated. This study aimed to evaluate whether mAbs is effective and safe in CM patients previously treated with BT-A, either as alternative or add-on treatment. We enrolled 47 patients: according to the response to BT-A treatment, patients were defined Non-responder (NR) and Partial-responder (PR). NR were shifted to mAbs. PR were randomly divided into those who added mAbs therapy (PR-P) and those who shifted treatment (PR-S), interrupting BT-A. Clinical variables were collected at baseline, after three and six months. Study results evidenced the efficacy of mAbs in improving clinical outcomes in CM patients, with a better response in PR group. No statistically significant differences of clinical changes were observed between PR-P and PR-S groups. No safety concerns were raised in combined treatments. Preventive prophylaxis with mAbs is effective, even in difficult to treat CM patients. Further studies, with a larger sample size, are needed to highlight a potential additive effect of combined therapies.