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Preventing migraines is shaping up to be the drug industry’s next big gold rush, a multibillion-dollar opportunity with four contenders vying to claim its lion’s share. But just which company triumphs will depend on satisfying patients, winning over payers, and — maybe — lining the pockets of doctors.

The key is a protein called CGRP, which plays a role in the dilation of the brain’s blood vessels. Block it and you can prevent the painful, debilitating headaches that plague roughly 40 million Americans, studies have shown. It’s by no means a cure, but doctors say shaving a few headache days off of a migraine sufferer’s monthly burden can make a world of difference.

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