A 60-year old female presented with fever, right-sided headaches, nausea and eye burning for 6-7 days. She was diagnosed with migraine and folliculitis. She was treated with antibiotics, analgesics, anti-emetics, anti-pyretics, anti-depressants, anti-inflammatories and topical antibiotics. Her symptoms improved after 5 days of treatment and she was discharged on medications to prevent recurrence.

1. CASE PRESENTATION ON
MIGRANE WITH FOLLICULITIS.
Submitted by:
MARTIN SHAJI
PHARM-D

2. PATIENT DEMOGRAPHIC DATA
Name: Mrs.k
Age/gender:60yrs /female
Admission .no:39443
Department: general medicine female-IV
Date of admission: 31/05/16
Date of discharge:4/06/16
Provisional diagnosis:
Fever with headache

3. Chief complaints:
Fever since 6 days, unilateral (right side)head ache since 7
days, nausea, burning sensation in eyes.
Past medical history:
Nothing significant
Allergies:
Nothing significant
Family history: Nothing significant
DIAGNOSIS:
Migraine with folliculitis.

4. DRUG CHART
s.no Drug name Indication Dose ROA Frequenc
y
Duration
1 T.Amoxycilli
npotassiumc
alvanate
Antibiotic 625 mg p/o BD 5days
2 T.pantaprazo
le
Anti-ulcer 40mg p/o OD 5days
3 Inj.Diclofena
c
Analgesic 50mg p/o BD 5days
4 Ondonsetron Anti-
emetic
4mg IV SOS 5days
5 T.Paracetam
ol
Anti
pyretic
500mg p/o TID 5days

5. 6 Amitry
ptilin
Anti
depress
ant
10mg p/o OD 5days
7 Sofram
ycin
Antibiot
ic
Topical BD 5days
8 Prednis
olone
Anti
inflam
matory
20mg p/o BD 5days

6. SOAP NOTES
Subjective evaluation:
A 60yrs female patient was admitted in female medical
ward with the chief complaints of fever since 6 days,
unilateral (Right side)headache since 7 days, nausea,
burning sensation in eyes.
Objective evaluation:
On general examination patient was conscious and
coherent she was response to external stimuli on
physical examination pt shows febrile condition
(99.4) with all normal vitals.

7. Assessment:
Based on subjective and objective evidence the patient was
diagnosed as “migraine with folliculitis”
so, the pt was treated with following medications
Inj.ceftriaxone:It is an antibiotic
Inj.pantop :It is an anti ulcer drug
Inj.diclofenac :It is an analgesic
Tab.paracetamol:it is an anti pyretic
Inj.ondon:It is an anti emetic.
Tab.Augmentin:it is an antibiotic
Oint.soframycin:It is an antibiotic.
Tab.CPM :It is an anti allergic.
Tab.Amitryptilin:It is an anti depressants.
Tab.Prednisolone:it is an anti inflammatory.

8. Planning:
On day-1 patient was complaints fever (99.8F)since 6 days
so she was treated with tab.paracetamol 500mg tid,
headache since 7 days treated with Inj.diclofenac 50mg bid
,nausea treated with Inj.ondon 4mg sos,pantop was given to
prevent ulcer formation due to poly pharmacy.
On day-2 patient had similar complaints so treated with same
medication.
On day -3 patient had similar complaints so treated with same
medication.
On day -4 patient was diagnosed with folliculitis so treated
with oint.soframycin bid, Tab.CPM 4mg od .
On day -5 pt shows decreased raised temperature ,migraine
headache and discharged with following medication,

9. Tab.Augmentin 625mg BD
Tab.pantop 40 mg OD
Tab.PCT 500mg SOS
Tab.Amityrptilin 10 mg OD
Tab. Prednisolone 20 mg BD
Oint.Soframycin BD
Pharmaceutical care issues:
The given prescription was rational.
No ADR & DDI was found.

10. Patient counselling:
Regarding disease:
Folliculitis is an inflammation of the hair folicles. It
may be caused by bacteria ,yeast or fungus. It shows
symptoms like red pimples with a hair in the centre of each
one, itch or burn, drains pus ,blood or both, small pimples
appear on stomach.
Headache can be cause mild, moderate and severe pain in head,
neck and behind eyes. It can be caused by muscle
contractions in the head and neck region.
Alcohol eye strain, dry ness, fatigue, smoking, cold or flu,
sinus, infections, poor posture, emotional stress may causes
for headache.

11. Regarding medication:
 T.Augmentin:
It is a anti biotic drug given to treat bacterial infections. It was
taken twice in a day after meals.it may cause GI irritation so
take plenty of water long with drug’
 T.Pantop:
It should be taken 30 mins before food. It taken once in dy on
morning. It prevent ulcer formation due to usage of more
number of drugs
 T.Paracetamol:
It is used to reduced elevated body temperature than the normal.it
is also reduced pains.it taken when patient feel temperature was
elevated than normal. It was taken after meals.

12. T.Amitryptilin:
It used to treat migraine headaches. It taken once daily before
sleep.it produce sedation effect to the patient. This medication
was used under the physician guidance only.it cause sedation
effect to the patient sudden cessation was not recommended.
Oint.soframycin:
It is an anti biotic ointment. It is used an topical application.it
applied on effect area after proper cleaning .it applied thin even
layer on skin present on head.
T.Prednisolone:
It is anti inflammatory drug .taken twice in a day after meals.
While taking this medication reduce salt intake, increase intake
of protein and potassium contain diet.it ma cause mood swings
and increased emotions.

13. Life style modifications:
 Strictly adhere to the medication.
 Avoid to hot baths it may worse the folliculitis condition.
 Maintain hygiene conditions.
 Apply a warm, moist wash cloth to the affected areas several
times in a day to relieve discomfort.
 Do not share your towels , washcloths.
 Apply lotion on affected areas to moist skin.
 Avoid unhygienic pools, baths.
 Avoid overload works to prevent headache attacks
 Avoid cold temperature it is may be trigger factor for
headache.
 Get enough sleep to control headache.
 Place an ice pack wrapped in a cloth on back of neck.

14. DISCUSSION:
Folliculitis is an inflammation on hair follicles, it is also known
as “hot tub folliculitis and barber’s itch". Folliculitis is caused
by an infection of the hair follicles by bacteria ,viruses, or
fungi.
CAUSES:
the most common cause of folliculitis is staphylococcus aureus
bacteria
• Friction from shaving or tight clothing.
• Excessive perspiration .
.
SYMPTOMS:
 Clusters of small red pus filled bumps that develop around the
hair follicles.
 Red and inflamed skin,

16. HEADACHE;
A migraine headache can cause intense throbbing or a
pulsing sensation in one area of the head is commonly
accompanied by nausea, vomiting ,extreme sensitivity to
light and sound
SYMPTOMS:
Prodorme (one or two days before)
o Constipation
o Depression
o Food cravings
o Hyperactivity
o Irritability
o Neck stiffness
o Uncontrollable yawning

17. CAUSES:
 Hormonal changes in women
 Foods
 Drinks (alcohol)
 Stress
 Sensory stimuli
 Changes in wake sleep pattern
 Physical factors
 Changes in the environment
 Medications (oral contaceptives & vasodilators)