The
View from Initialized

Migraines cost U.S. employers $13B a Year. Here’s How Mable Health is Helping to Personalize Migraine Treatments

How Mable fits into our healthtech thesis on data driving new advances in precision medicine and better patient experiences and outcomes. 

Roman Rothaermel came up with the idea for Mable in 2021 after completing his Ph.D. in Neuroscience at The University of Oxford. Both his father — who spent his career in medicine as a neurologist — and his girlfriend suffered from chronic migraines and spent years trying to find the right medication.

Turns out, their struggle was pretty common and a business idea worth pursuing. There are nearly 40 million Americans who suffer from migraine headaches. Chronic migraine sufferers experience at least 15 headaches a month, leading to productivity loss in the workplace. Migraines are known to cost U.S. employers at least $13 billion a year.

The current standard of care is woefully inadequate for patients. While there are 25 treatment options for migraines, neurologists have never been able to predict which drugs would be effective for any given patient. 

We met Roman through YC last year and were immediately impressed by his passion and persistence in personalizing migraine treatments. For example, one patient in Mable’s initial clinical study tried 18 treatments before finding one that worked.  

“We are moving away from a one-size-fits-all approach into individualized medicine. That’s the most important change currently happening in health care — the shift towards a very patient-centric care model,” said Roman. “And at the same time, we are also focusing very much on accessibility, as well as convenience. New technology leading to telehealth has allowed good medical care to be broadcast to even remote areas.”

Our thesis on data-driven medicine

Mable fits into our healthtech thesis on data driving new advances in precision medicine and better patient experiences and outcomes. 

Here’s how it works: the company collects genetic and phenotypic biomarkers to provide an individual migraine subscription for each patient. In simple terms, patients take a painless at-home cheek swab and fill out a simple clinical survey which helps the team create a personalized prescription for them. Later, Mable provides ongoing prescriptions and follow-up care.

Precision medicine tailors treatments to individuals based on their genes, environment, and lifestyle.  

We expect Mable’s pharmacogenetic approach to be applicable to other health conditions in areas closest related to migraines in the future. 

Large unserved need for migraine care

We believe that the patient need here is acute. Over a billion people worldwide suffer from migraines, with attacks peaking during the most productive professional years between the ages of 25 to 55 years old. Yet, the National Institutes of Health spent only $40 million on migraine research in 2021 versus $218 million on epilepsy.

This is due to a shortage of neurologists and despite the fact that migraines are the third most prevalent and sixth most disabling medical illness in the world.

“Even renowned headache experts admit, time and time again, that they just guess when they prescribe a new medication to a patient, and the number one thing missing in migrant care is a good biomarker system,” said Roman. “That is precisely why we want to bring genetics into migrant care.”

Unique, defensible technology and approach

The complexity of novel genetic biomarkers poses a barrier to their adoption into routine clinical practice. Mable is bridging the disconnect between the realm of pharmacogenetics and routine clinical practice. They do this by providing physicians a platform enabling them to embed genomic information within the patient’s medical history and apply optimized clinical workflows developed by renowned migraine specialists.

While Mable’s sequencing method is based on Illumina reagents and technology, Mable has been the first to do the CLIA validation for low pass sequencing from swabs and apply it within telehealth. 

Finally, Mable’s dataset, methods, and software will continuously refine as the patient population they have served grows and matures.

Note: Mable is launching in 10 states with a waiting list of 5,000. The plan is to be in 42 states by the end of August.