I am starting to realize that perhaps not everyone understands why tryptans work for some people sometimes but not all the time and why they don’t work for others at all ever. So here I try to give you an explanation so you can relate to it and not be puzzled.
There are 2 reasons and I present this in 3 cases why tryptans (or serotonin enhancing drugs) do or do not work. But first, you must understand that the job of brain cells (or neurons) is to manufacture neurotransmitters–such as serotonin, dopamine, etc. Some brain cells only make one neurotransmitter and others make more–in research labs at Berkeley when I once visited, I have seen neurons making up to 3 different types of neurotransmitters. One of those may be serotonin but the others are not.
The reason why tryptans are typically used for migraines–as well as for depression–is because it is assumed that you have not enough serotonin and if you have more, it will make you feel better.
It will, if and only if the neurotransmitters that are in trouble and not working are of the kind that make serotonin and they are not producing it for whatever reason. But if the neurons not working are of the kind that normally manufacture some other neurotransmitter and they are not manufacturing it now, then you are not in need for serotonin replacement. Thus if then you get serotonin for your migraine, it will not work–you have enough serotonin.
The tryptan drugs sometimes work and other times don’t work is because sometimes it is the serotonin making neurons that don’t have enough energy to make serotonin, in which case serotonin replacement saves the day.
The tryptan is not working even though other times it often has worked. This means that this time the neurons that are idle are not serotonin making neurons. You still get the same migraine but something else is missing and not serotonin.
If you never find tryptans working for you it is because you never happen to have those neurons down that make serotonin.
This complicates a lot of things for doctors who are searching for the cause of the pain rather than the cause of the problem to start with. Most drugs–including Calcitonin gene-related peptide receptor antagonists for migraine–are after pain and not cause. This explains why only 30% of the people are helped with tryptan and also with Calcitonin gene-related peptide receptor antagonists and not all. Don’t misunderstand, 30% is a huge percent, particularly if you happen to be in that 30% but remember that it is still just a band-aid and the migraine initiating factors remain, only now you don’t feel them.
What that means is that if you have migraines that you do not feel, you may still progress to strokes, seizures and hemiplegic migraine state since the migraine cause was not stopped and parts of your brain are still not functioning. Thus you will potentially develop more serious conditions later since the underlying condition is not treated.
I hope this helps in understanding the many treatments available today–including botox, electric devices, etc. They do not cure only act as pain killers. To date, the only research that is purely for the cause of migraines is found in the book Fighting the Migraine Epidemic. The link here is only to one site, the author’s site, but it is widely available everywhere, including in very inexpensive e-book format for around $3.50 depending on where you buy it. If you want to understand the cause and treat the cause rather than just the pain, and if you want to prevent migraine, read that book.
Let me know if you have any questions.