About 40 million people in the U.S. suffer from migraines. Yet, migraine mechanisms are only just now understood. That's good news for better medicines, and Charlie Conway of Biohaven Pharmaceuticals discusses how his corner of pharma has developed a targeted therapy with great promise. Listen and learn

• How migraine headaches and related symptoms result from an over-activated trigeminal nerve in the brain that releases CGRP;
• Why CGRP causes debilitating symptoms including pulsing headaches, light and sound hypersensitivity, and nausea; and
• How they've developed CGRP-targeted therapies that either block the receptors or absorb the excess.

Charlie Conway is the Chief Scientific Officer at Biohaven Pharmaceuticals. His background includes a postdoc on neuroscience and pain sensing. He brings listeners up to speed on the latest research on brain cells and migraines, including how the physiology leads to overactive nerve cells and debilitating pain. It starts with a trigger of the trigeminal nerve, which sits on either side of the brain stem. The exaggerated trigeminal nerve activity then changes the response properties deeper in the brain, releasing a chemical called calcitonin gene-related peptide, or CGRP. In addition, because nerve cells are able to stretch, they're in key positions to absorb CGRP; in fact, a single cell in the brainstem can send up fibers that connect to the outer brain tissue.

When the CGRP is released, the proteins hit a few different areas of the brain, including this outer brain tissue called the dura. This leads to over-excited nerves and what's called neurogenic inflammation. He describes the additional biological events that lead to the pain migraine suffers experience. But Biohaven's anti-CGRP targeted therapies prevent this cascade. In fact, they've shown that the treatments are effective for both acute migraines, as well as prevention. That prevention is what makes their therapy unique and especially promising. Listen in for more about what they've developed, how it compares to other therapies, if there are possible risks, and how this can make a substantial difference. Episode also available on Apple Podcasts: apple.co/30PvU9C