15 May 2022 |

The Next Frontier of Migraine

By Jared Dashevsky

Fresh off a profitable fiscal year, Pfizer will use its cash to acquire Biohaven Pharmaceuticals for $11.6B—their largest acquisition since 2016. Biohaven focuses on neurological and neuropsychiatric diseases like migraines, which are often overlooked and untapped in therapeutics.

The Deets
The $11.6B deal will give Pfizer access to Biohaven’s innovative calcitonin gene-related peptide (CGRP)-targeting migraine medications:

  • Rimegepant (Nurtec): FDA-approved for prevention and acute treatment of migraines.
  • Zavegepant: Recently submitted to FDA for approval. It’s a nasal spray used to prevent and treat migraines.
  • Five pre-clinical CGRP medications: Too early to say anything about these drugs, but Pfizer sees potential.

Pfizer plans to broaden Nurtec’s reach to patients, for which there’s a lot of potential—Biohaven estimates Nurtec represents just under 50% of the CGRP drug market. Pfizer, therefore, plans to double Nurtec’s sales team and reach an additional 70K primary care providers and Ob/Gyns.

CGRP and the Next Frontier of Migraine
CGRP is a peptide that modulates neuronal pain and vascular activity and is thought to drive migraines. The above drugs antagonize CGRP receptors, blocking their activity. Other CGRP medications include monoclonal antibodies, which bind to CGRP receptors and also block their activity. Despite being relatively new, CGRP drugs are promising and are another effective tool to prevent or treat migraines.

My Thoughts
Have you ever had a migraine? It’s the worst. I get them when my sleep dips below 7 hours for several nights in a row. I can’t function. Here are three things to know about migraine:

  1. It’s common, affecting around 12% of the U.S. population, and is 2-3x more common in women than men.
  2. It’s the number two cause of disability worldwide, and number one among young women.
  3. It’s a major public health issue that receives little attention.

There are several ways to prevent and treat migraine, including lifestyle changes and medications. Nothing yet has been groundbreaking per se, but drugs targeting CGRP receptors may be what we need—and Pfizer thinks so, too. Given migraine is an often overlooked neuropsychiatric disease, Pfizer may be the “big guy” to start leading the charge into migraine therapeutics.

Regarding digital mental health, there are a few companies targeting migraine prevention and treatment. Cove is one company that caught my eye. With Cove, you can schedule a consultation and get medical treatment (like Nurtec) that fits what you need and what your insurance covers. Similarly, Neurahealth is an app-based platform that tracks your migraine triggers (read: monitoring lifestyle factors) and shares them with a neurologist who can provide a treatment plan.

Overall, migraine is a common, disabling condition worldwide and hasn’t received the attention it needs, in my opinion. However, I think Pfizer’s acquisition of Biohaven may start a “race” to develop the most effective migraine treatment while digital health startups focus on facilitating access to providers and treatments.