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Kianjokoma in the cold

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Migraine Explained

Introduction
A migraine is a type of a headache which usually occurs in
adolescents or young adults.Headache of a migraine occur on one
side of the head or in the whole head and 60-80% of a migraine
headache are familial.A migraine is more common in female than
in males.A migraine headache occurs in attacks and each attacks of
a headache usually last from a few hours to 2 days while the
frequency of attacks may vary from one or more attacks in a week
to one attack in a year.A migraine is usually precipitated by
emotional or physical stress apart from this migraine can also be
precipitated by missed meals, sleep disturbances, menstrual
periods, alcohol, foods and oral contraceptives.The severity of A
headache varies in different patients it may he throbbing pain or
sometimes it may be dull.migrain may also be associated with
vomiting and nausea.it may be preceded or accompanied by certain
neurological symptoms such as luminous visual hallucination.A
migraine occurs due to the involvement of trigeminal the
perivascular spaces.This perivascular edema may cause the
stretching of pain receptors in the dural membrane, causing a
headache of a migraine.Also, it has been found that sometimes
during a migraine, the amplitude of pulsation of temporal arteries
is increased.During aura, there is an abnormal release of serotonin
from the platelets, but during headache of migraine serum
serotonin fall below normal.
There is another type of a migraine headache which is more
common in males than in females which are called Cluster
Headache in this type of a headache there is very severe pain
around an eye with redness of the eye and watering from the nose
and eye.Usually, occurs in people age 30 or more and its attack
usually occurs after every 12-18 months.Attack occurs usually at
night and each attack last 1-2 hours.They remain for one to three
weeks during each cluster.
Classification Of Migraine Drugs
There are two group of Migraine Medication /s Which are,
(A) Drugs For the treatment of Acute Attack
(1)5-HT1 Agonist:
Zolmitriptan
Sumatriptan
Rizatriptan
Naratriptan
(2)Other Migraine Medication /s
Ergotamine
Paracetamol
Opioids
Dihydroergotamine
NSAIDs
(B)Prophylactic Drugs
Aspirin
Pizotifine
Propranolol
Amitryptyline
Fluoxetine
Flunarizine
Cyproheptadine
Clonidine
Methylsergide
Sertraline
Ergotamine
Ergotamine is one of the best Migraine Medication and It is an
alkaloid obtained from a fungus known as cleviceps purpurea.This
Fungus infest the rye and some other grains and grasses.
Pharmacokinetics
It is given orally,sublingually,inhalationaly,by rectal route and by
intramuscular injection.When given orally it is absorb from the
intestine and its absorption is variable.After metabolism the drugs is
excreted in urine.Caffeine increases its absorption from the intestine.
Adverse Effects:
Nausea ,vomiting and diarrhea are the most common adverse effects.
Large doses can cause spasm of the blood vessels of the arms and legs
thatmay lead to their gangrene.Rarely gangrene of intestine can occur
due to spasm of mesentric artieries.
Contraindications
Perilheral vascular disease such as Reynaud disease and buerger
disease.in these disease arteries of the limb are narrowed .
Collagen disease.
Ischemic heart disease
Its better to avoid in pregnant women though there is no evidence of
harmful effects.
Triptans
These are a group of drugs that are recently being most commonly
used in acute attack of migraine.Their mechanism of action appears
to be similar to that of ergot alkaloids.
Sumatriptan
It is a 5HT1B and 5HT1D agonist and it is a great Migraine Medication
which is effective in both migraine headache and cluster headache.its
effectivenessin these conditions is equal to or more than that of ergot
alkaloids.
Pharmacokinetics
When given orally only 15% of sumitriptan is absorbed into the
systemic circulation.its plasma half life is two to three hours.it can be
used orally,subcutaneously and as a nasal spray.
Adverse effects:
Sumitriptan is well tolerated .it can cause mild degree of abnormal
sensation such as dizziness,muscle weakness,tingling,pain in the
chest ,pain in the neck and pain at the site of injection.
As it is short acting several doses of drug maybe need during a
prolonged attack of migraine.However no more than two doses should
be given per day.
Other triptans
Naratriptan
It is also a 5HT1B and 5HT1D agonist.
Use 2.5mg of naratriptan orally after an attack of migraine .
When used orally 40-70% of drug is absorbed from the intestine into
systemic circulation.
If migraine recurs then 2.5mg can be used again after 4 hours of
intial dose.
If the patient doesn’t respond to the first dose don’t use it again for
the same attack.
A maximum of 5mg can be used per day.
Not recommended for patient below 18 year of age.
Plasma half life is about 6 hours
Mechanism and adverse reactions are similar to that of sumitriptan.
Rizatriptan
This drug is also a 5HT1B and 5HT1D agonist and is also a best
Migraine Medication .
Mechanism and adverse effect are similar to that of sumatriptan.
when used orally 40-70% absorbed from the small intestine into the
systemic circulation.
10mg can be used orally at the onset of an attack and if the migraine
recurs then a second dose can be given after 2 hours of the first dose.
Keep that mind if the patient doesn’t respond to first dose then
second dose is not used.
Maximum daily dose is 20mg and it is not recommended for children
below 18 years.
Almotriptan
Daily recommended Dose is 25 mg.
It is used in a dose of 12.5mg orally as soon as possible after the onset
of migraine attack.
For recurrence of migraine a second dose should not be given before
2 hours of the first dose.
If there is no response to the first dose,second dose is not given for
the same attack .
It is not recommended in children below 18 years.
Eletriptan
It is used in a dose of 40mg orally as soon as possible after the onset
of migraine attack and repeated after 2 hours if recurs.
A second dose is not used if there is no response to the first dose.
Contraindications of triptans
Almotriptan is contraindicated in severe hypertension.
All of 5HT1 Agonist are contraindicated in agina pectoris,because
they produce spasm of coronary arteries.
Zolmitriptan is contraindicated in wolf-parkinson-white syndrome.
Sumatriptan,rizatriptan,almotriptan,eletriptan,and zolmitriptan are
short acting drugs and therefore several doses of these drugs are
required during a prolonged attack.
Noratriptan and almotriptan are contraindicated in severe hepatic
and renal diseases and in peripheral vascular diseases.
NSAIDS
All NSAIDs can be used as a Migraine Medications in the treatment of
acute attack of migraine.
Opioids may be used in severe cases of migraine not responding to
other drugs.As they cause addiction ,care should be taken during their
use.
Prophylactic Migraine Medication /s
Following are the important Migraine Medication /s that can be used
in the prevention of migraine.
Drugs Prophylactic Dose
Aspirin 300mg twice daily
Prpranolol 80-240mg/Day in 3-4 doses
Imipramine 10-150mg daily in single dose
Amitriptyline 10-150mg daily in single dose
Fluoxetine 20-60mg in a single dose
Sertraline 50-200mg in a single dose
Clonidine 0.2-0.6mg daily
Mrthylsergide maleate 4-8 mg daily
Verapamil 80-160mg daily
Ergonovine maleate 0.6-2mg daily
Cyprophetadine 12-20mg daily.

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Embu county photosphere

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When Man Made god

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The bible states clearly that one should not worship
another god except the Supreme God. The worship of
graven images and foreign gods was a major
abomination esp in the bibilical times and this sin
brought outward consequences including Babylonic
exiling.
The are four major gods made by men for worship
especially as import to Israel from foreign nations;
ASHERAH. This was a multi-breasted god of sex. This
was a god of increase and multiplication. Today
everyone wants to get rich and get money to make life
posh. The yearn for wealth has been the hallmark of
everyone and some can even sell their blood-child to
get increase,we give God on condition that increase is
forthcoming. Quit playing the field.
MOLECH. A god of pleasure. In today’s life we’ve seem
have a surge towards embrace of sex worship any other information
import of strange and unnatural acts of sex.
Psychology states everyone has some sexual
orientation to which one can earn sexual satisfaction.
The obsession for pleasure and ‘feeling good attitude’
is the centre-bolt of many of us. We value
entertainment and addiction to objects of leisure and
calmness. We savor posh and getting the best out of
everything. The worse of it is pleasure at others peril.
Quit playing the field.
BAAL. This was a respected god in those times referred
as lord or master. Anything that is your master in your
life is your Baal. Things we sacrifice to, things we
perhaps cant live without,favourite programs, assets
we value, people we savor, those secret sins only devil
knows about them..name them.. Quit playin the field.
HAAMAN. A god of power, obsession for success,
intellect worship. Today we see men who have
superiority complex.. You want to be noticed, to be in
control, the centrestage, an icon, star, beauty queen.
We want better brains and be think-tanks with less
common sense, many degrees like thermometer and
love solemn. Quit playing the field.

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Unbroken

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Unending

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Undeterred

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Unequivocal

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Unrelenting

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Camera work by, hopeimpacters

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Songs and stories

WHY I ONLY SING IN THE BATHROOM
I lifted the silver microphone amidst crowds’ applause, chilling and mighty that I
almost sunk to self. I graced the moment with an entry jig and I knew I had set
the crowd rolling. I gathered the dust of the fading applause and then everyone
waited I unleash the rocks. I knew I had rocked before and I would rock. I waited
for the inner self to assure me that all was well as the floor grew cold. The
moment after cheers and jeers can be the most traumatizing. The microphone
grew colder, the carpet grew hotter and all I hoped for was the heavens . What do
we do when the sphincteric muscles play a loose game and all you know you
soaked not only soaked with sweat but also urine streaks. I reached for a greater
strength inside and a peaceful culmination could not calm the evidently frustrated
crowd. At least I gazed in a transfixed gait and with this rock hard stature my
face turned stone. Half crowd was clapping and the other half was booing.
The mic fell on the floor, the judges getting mad before I uttered my first word. I
remember the song ‘you move mountains, you cause walls to fall’.
I swayed my head and shoulders as they threw pens and erasers at my side. I
had frustrated my expectant fans. They had lost trust in me. A man in the crowd
held a big stone in his hand ready to throw it to me. This is when my feet felt
strong enough to help me leave the carpeted stage.
I have tens of songs in my head before the end of my bath time. It looks calm.
The warm drops soothe my shoulders. The water sounds like an applause, alas! I
am water borne. I sing one song after the other; at least no one is watching and
no longer afraid. It is hilarious to sing in the bathroom.

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Embu landslide #kianjokoma kanyakiri

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