const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Headache: A Comprehensive Clinical Overview";
pres.author = "Orris - Based on Harrison's 22E & Adams and Victor's Neurology 12E";

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// ── MASTER HELPERS ─────────────────────────────────────────────────────────
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════════
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OUTLINE / TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════════════════
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  addHeader(s, "Presentation Outline");
  addFooter(s);

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    ["01", "Definition & Epidemiology"],
    ["02", "Classification (IHS / ICHD-3)"],
    ["03", "Pathophysiology"],
    ["04", "Red Flag Signs (SNOOP4)"],
    ["05", "Clinical Features – Migraine"],
    ["06", "Clinical Features – Tension-Type & Cluster"],
    ["07", "Diagnosis & Investigations"],
    ["08", "Treatment – Acute (Migraine)"],
    ["09", "Treatment – Preventive (Migraine)"],
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    ["11", "Secondary Headaches"],
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – SECTION DIVIDER: DEFINITION & CLASSIFICATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Definition & Classification", "Section 01 – 02");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – DEFINITION & EPIDEMIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Definition & Epidemiology");
  addFooter(s);

  // Left column – definition box
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  s.addText("Headache is pain or discomfort in the head, scalp, or neck. It ranks among the most common neurological complaints and is caused by activation of pain-sensitive structures in and around the skull and brain.", {
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    bullet("~50% of adults experience headache in any given year (Global Burden of Disease)"),
    bullet("Migraine: ~15% lifetime prevalence; F > M (3:1)"),
    bullet("Tension-type headache: most common type (~40% lifetime prevalence)"),
    bullet("Cluster headache: rare, M > F (~5:1); 0.1% prevalence"),
    bullet("Headache is the 3rd leading cause of disability worldwide (GBD 2019)"),
  ], { x: 0.3, y: 2.42, w: 4.6, h: 2.8, fontFace: "Calibri", valign: "top" });

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    bullet("Middle meningeal and dural arteries", { color: C.white, fontSize: 12 }),
    bullet("Basal meninges", { color: C.white, fontSize: 12 }),
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CLASSIFICATION (IHS / ICHD-3)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Classification of Headache – ICHD-3 (IHS)");
  addFooter(s);

  // Part 1 – Primary
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  s.addText("PRIMARY HEADACHES", { x: 0.3, y: 0.92, w: 2.9, h: 0.38, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle" });
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    subbullet("With / without aura", { color: C.lightgray }),
    subbullet("Chronic migraine", { color: C.lightgray }),
    bullet("Tension-type headache (TTH)", { color: C.white, fontSize: 11 }),
    subbullet("Episodic / Chronic TTH", { color: C.lightgray }),
    bullet("Trigeminal autonomic cephalalgias (TAC)", { color: C.white, fontSize: 11 }),
    subbullet("Cluster headache", { color: C.lightgray }),
    subbullet("Paroxysmal hemicrania", { color: C.lightgray }),
    subbullet("SUNCT/SUNA", { color: C.lightgray }),
    bullet("Other primary headaches", { color: C.white, fontSize: 11 }),
    subbullet("Primary cough headache", { color: C.lightgray }),
    subbullet("Primary exercise headache", { color: C.lightgray }),
    subbullet("Hypnic headache", { color: C.lightgray }),
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  s.addText("SECONDARY HEADACHES", { x: 3.6, y: 0.92, w: 2.9, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
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    bullet("Attributed to head/neck trauma", { color: C.white, fontSize: 11 }),
    bullet("Cranial or cervical vascular disorder", { color: C.white, fontSize: 11 }),
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    bullet("Non-vascular intracranial disorder", { color: C.white, fontSize: 11 }),
    subbullet("Raised ICP, CSF hypotension, neoplasm", { color: C.offwhite }),
    bullet("Substance use / withdrawal", { color: C.white, fontSize: 11 }),
    subbullet("Caffeine, analgesic overuse", { color: C.offwhite }),
    bullet("Infection", { color: C.white, fontSize: 11 }),
    subbullet("Meningitis, encephalitis", { color: C.offwhite }),
    bullet("Homeostasis disorders", { color: C.white, fontSize: 11 }),
    subbullet("Hypertension, hypoxia", { color: C.offwhite }),
    bullet("Cranial nerve / eye disorders", { color: C.white, fontSize: 11 }),
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  // Part 3 – Neuropathies
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  s.addText("CRANIAL NEURALGIAS", { x: 6.9, y: 0.92, w: 2.8, h: 0.38, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle" });
  s.addText([
    bullet("Trigeminal neuralgia", { color: C.white, fontSize: 11 }),
    bullet("Occipital neuralgia", { color: C.white, fontSize: 11 }),
    bullet("Glossopharyngeal neuralgia", { color: C.white, fontSize: 11 }),
    bullet("Nervus intermedius neuralgia", { color: C.white, fontSize: 11 }),
    { text: "\nFrequency", options: { bold: true, color: C.gold, fontSize: 12, breakLine: true } },
    bullet("TTH: ~40%", { color: C.lightgray, fontSize: 11 }),
    bullet("Migraine: ~15%", { color: C.lightgray, fontSize: 11 }),
    bullet("Cluster: ~0.1%", { color: C.lightgray, fontSize: 11 }),
    bullet("Secondary: ~10%", { color: C.lightgray, fontSize: 11 }),
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – SECTION DIVIDER: PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Pathophysiology", "Section 03");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – PATHOPHYSIOLOGY OF MIGRAINE (1)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Pathophysiology of Migraine – Trigeminovascular System");
  addFooter(s);

  // Central concept box
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  s.addText("Core concept: Migraine results from activation of the trigeminovascular system — pain fibres from the trigeminal ganglion innervating dural and pial blood vessels — combined with cortical excitability changes.", {
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  // Column 1
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  s.addText("Cortical Spreading Depression (CSD)", { x: 0.45, y: 1.6, w: 4.3, h: 0.3, fontSize: 13, bold: true, color: C.indigo, fontFace: "Calibri" });
  s.addText([
    bullet("Wave of neuronal and glial depolarisation spreading at 2–3 mm/min across cortex (Leão 1944)"),
    bullet("Correlates anatomically and temporally with the visual aura (Lashley calculations)"),
    bullet("Oligemia follows CSD: reduced CBF spread from occipital cortex forward (Olesen; PET; MRI)"),
    bullet("CSD activates trigeminovascular pain fibres, triggering the headache phase"),
    bullet("Does NOT respect arterial territories — distinguishes from ischaemia"),
  ], { x: 0.45, y: 1.92, w: 4.3, h: 3.3, fontFace: "Calibri", valign: "top" });

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  s.addText("Trigeminovascular Activation & CGRP", { x: 5.3, y: 1.6, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.teal, fontFace: "Calibri" });
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    bullet("Trigeminal nerve fibres (Aδ and C fibres) innervate meningeal vessels"),
    bullet("Activation → release of CGRP, Substance P, neurokinin A from perivascular fibres"),
    bullet("Neurogenic inflammation: plasma extravasation, mast cell degranulation, vasodilation"),
    bullet("Signal relayed via trigeminal ganglion → trigeminocervical complex (TCC) → thalamus → cortex"),
    bullet("CGRP levels ↑ in jugular blood during attacks; normalised by sumatriptan (Harrison's 22E)"),
    bullet("Anti-CGRP monoclonal antibodies highly effective in migraine prevention (mechanism confirmation)"),
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – PATHOPHYSIOLOGY (2): CENTRAL SENSITISATION & GENETICS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Pathophysiology – Central Sensitisation, Brainstem & Genetics");
  addFooter(s);

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    { x: 0.25, color: C.indigo, title: "Central Sensitisation", items: [
      "Second-order neurons in TCC become sensitised → allodynia (cutaneous allodynia in 70% of migraineurs)",
      "Third-order (thalamic) sensitisation → widespread allodynia",
      "Explains why triptans are less effective once allodynia starts",
      "Drives chronification when attacks are frequent and undertreated",
    ]},
    { x: 3.55, color: C.teal, title: "Brainstem & Hypothalamus", items: [
      "PET: dorsal raphe nucleus, locus coeruleus, nucleus raphe magnus activated during attacks",
      "Modulate trigeminovascular input (descending modulation)",
      "Hypothalamic activation in the PREMONITORY phase (hours before pain)",
      "Explains prodromal symptoms: yawning, food craving, fatigue, mood changes",
      '"Migraine generator" — activity persists even after pain resolves',
    ]},
    { x: 6.85, color: C.navy, title: "Genetics & Triggers", items: [
      "~40% familial incidence (with aura); polygenic in most forms",
      "~40 susceptibility loci identified; many in vascular smooth muscle genes",
      "Familial Hemiplegic Migraine: CACNA1A, ATP1A2, SCN1A — ion channel mutations",
      "Triggers: oestrogen withdrawal, sleep changes, fasting, stress let-down, certain foods, weather",
      "Overresponsiveness to environmental change, NOT excess stress per se (Harrison's 22E)",
    ]},
  ];

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    s.addText(title, { x: x + 0.08, y: 0.9, w: 2.75, h: 0.38, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.shapes.RECTANGLE, { x: x + 0.3, y: 1.3, w: 2.3, h: 0.04, fill: { color: C.gold }, line: { color: C.gold } });
    const bulletItems = items.map((t, i) => ({
      text: "• " + t,
      options: { breakLine: true, fontSize: 10.5, color: i === 0 ? C.white : C.lightgray, fontFace: "Calibri" }
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    s.addText(bulletItems, { x: x + 0.1, y: 1.38, w: 2.75, h: 3.75, fontFace: "Calibri", valign: "top" });
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – SECTION DIVIDER: RED FLAGS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Red Flag Signs", "Section 04 – SNOOP4 Mnemonic");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – RED FLAGS (SNOOP4)
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "dark");
  addHeader(s, "Red Flag Signs in Headache – SNOOP4 Mnemonic");
  addFooter(s);

  const flags = [
    { letter: "S", label: "Systemic symptoms / disease", detail: "Fever, weight loss, malignancy, HIV/immunosuppression, meningism → consider meningitis, SAH, metastases" },
    { letter: "N", label: "Neurological signs/symptoms", detail: "Focal deficits, seizure, altered consciousness, papilloedema → space-occupying lesion, CVT, stroke" },
    { letter: "O", label: "Onset (sudden/thunderclap)", detail: "\"Worst headache of life\" reaching peak within seconds → Subarachnoid Haemorrhage until proven otherwise" },
    { letter: "O", label: "Older age (>50 yrs, new headache)", detail: "New headache >50 yrs → giant cell arteritis, intracranial malignancy; check ESR/CRP, temporal artery biopsy" },
    { letter: "P", label: "Pattern change / Progressive", detail: "Change in established pattern, increasing frequency, severity or refractory headache → raised ICP, tumour" },
    { letter: "P", label: "Positional aggravation", detail: "Worse lying down → raised ICP; worse standing → CSF hypotension (post-LP, spontaneous)" },
    { letter: "P", label: "Precipitated by Valsalva/exertion", detail: "Cough, Valsalva, exertion, sexual activity → posterior fossa lesion, Arnold–Chiari malformation" },
    { letter: "P", label: "Post-traumatic onset", detail: "Following head injury → subdural/extradural haematoma, cerebral contusion" },
  ];

  flags.forEach(({ letter, label, detail }, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i % 4;
    const x = col === 0 ? 0.2 : 5.1;
    const y = 0.9 + row * 1.12;
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.44, h: 0.88, fill: { color: C.red }, line: { color: C.red } });
    s.addText(letter, { x, y: y + 0.08, w: 0.44, h: 0.72, fontSize: 28, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.shapes.RECTANGLE, { x: x + 0.44, y, w: 4.5, h: 0.88, fill: { color: C.indigo }, line: { color: C.indigo } });
    s.addText(label, { x: x + 0.5, y: y + 0.03, w: 4.3, h: 0.27, fontSize: 11.5, bold: true, color: C.gold, fontFace: "Calibri", valign: "middle" });
    s.addText(detail, { x: x + 0.5, y: y + 0.3, w: 4.3, h: 0.55, fontSize: 9.5, color: C.lightgray, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – SECTION DIVIDER: CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Clinical Features", "Section 05–06 – Migraine, TTH, Cluster");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – MIGRAINE: PHASES & SYMPTOMS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Migraine – Clinical Features & Phases");
  addFooter(s);

  const phases = [
    { name: "PRODROME\n(hrs–days before)", color: C.navy, items: [
      "Yawning, food craving",
      "Fatigue, mood changes",
      "Neck stiffness, polyuria",
      "Photophobia, phonophobia",
      "Occurs in ~60% of patients",
    ]},
    { name: "AURA\n(20–60 min)", color: C.indigo, items: [
      "Visual (most common): scintillating scotoma, fortification spectra, homonymous hemianopia",
      "Sensory: hemisensory pins & needles, numbness",
      "Language: dysphasia (rare)",
      "Motor: rare (hemiplegic migraine)",
      "CSD correlate (2–3 mm/min spread)",
    ]},
    { name: "HEADACHE\n(4–72 hrs)", color: C.teal, items: [
      "Unilateral in 60% (bilateral in ~40%)",
      "Pulsatile/throbbing quality",
      "Moderate to severe intensity",
      "Aggravated by routine activity",
      "Nausea ± vomiting",
      "Photophobia + phonophobia",
      "Prefers quiet, dark room",
    ]},
    { name: "POSTDROME\n(hrs–day after)", color: C.midgray, items: [
      "Fatigue, cognitive fog",
      '"Hangover" sensation',
      "Scalp tenderness (allodynia)",
      "Mood changes",
      "Can last up to 48 hours",
    ]},
  ];

  phases.forEach(({ name, color, items }, i) => {
    const x = 0.15 + i * 2.45;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y: 0.88, w: 2.3, h: 0.52, fill: { color }, rectRadius: 0.08, line: { color: C.gold, pt: 1.5 } });
    s.addText(name, { x: x + 0.05, y: 0.9, w: 2.2, h: 0.48, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    // Arrow
    if (i < 3) {
      s.addShape(pres.shapes.RIGHT_ARROW, { x: x + 2.3, y: 1.02, w: 0.15, h: 0.28, fill: { color: C.gold }, line: { color: C.gold } });
    }
    const bulletItems = items.map((t) => ({ text: "• " + t, options: { breakLine: true, fontSize: 10.5, color: C.navy, fontFace: "Calibri" } }));
    s.addText(bulletItems, { x, y: 1.45, w: 2.3, h: 3.75, fontFace: "Calibri", valign: "top" });
  });

  // ICHD-3 diagnostic criteria box at bottom
  s.addShape(pres.shapes.RECTANGLE, { x: 0.15, y: 5.12, w: 9.7, h: 0.28, fill: { color: C.indigo }, line: { color: C.indigo } });
  s.addText("ICHD-3 Migraine Without Aura: ≥5 attacks, 4–72h, unilateral + pulsating + moderate/severe + aggravated by activity + nausea/vomiting OR photo/phonophobia", {
    x: 0.2, y: 5.13, w: 9.6, h: 0.25, fontSize: 9, color: C.white, fontFace: "Calibri", italic: true, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – TENSION-TYPE & CLUSTER HEADACHE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Tension-Type Headache vs. Cluster Headache");
  addFooter(s);

  // TTH
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.25, y: 0.88, w: 4.55, h: 4.38, fill: { color: C.offwhite }, rectRadius: 0.1, line: { color: C.indigo, pt: 2 } });
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.25, y: 0.88, w: 4.55, h: 0.42, fill: { color: C.indigo }, rectRadius: 0.08, line: { color: C.indigo } });
  s.addText("TENSION-TYPE HEADACHE", { x: 0.3, y: 0.89, w: 4.45, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  s.addText([
    bullet("Most common headache type (~40% lifetime)"),
    bullet("BILATERAL — pressing/tightening (non-pulsatile)"),
    bullet("Mild to moderate intensity"),
    bullet("NOT aggravated by routine physical activity"),
    bullet("No nausea/vomiting (key distinguishing feature)"),
    bullet("Photophobia OR phonophobia (not both)"),
    bullet("\"Band around the head\" or \"vice-like\" quality"),
    bullet("Duration: 30 min to 7 days"),
    bullet("Episodic (<15 days/month) vs Chronic (≥15 days/month)"),
    bullet("Often persists day-long; present on waking"),
    bullet("Associated with anxiety, depression, muscle tenderness"),
    { text: "Pathophysiology: peripheral sensitisation of pericranial myofascial tissue; central sensitisation in chronic TTH (Adams & Victor)", options: { fontSize: 10, color: C.midgray, italic: true, breakLine: true } },
  ], { x: 0.3, y: 1.35, w: 4.38, h: 3.8, fontFace: "Calibri", valign: "top" });

  // Cluster
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: 0.88, w: 4.55, h: 4.38, fill: { color: C.offwhite }, rectRadius: 0.1, line: { color: C.red, pt: 2 } });
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: 0.88, w: 4.55, h: 0.42, fill: { color: C.red }, rectRadius: 0.08, line: { color: C.red } });
  s.addText("CLUSTER HEADACHE", { x: 5.25, y: 0.89, w: 4.45, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  s.addText([
    bullet("Rare but extremely severe; M:F = 5:1"),
    bullet("UNILATERAL orbital/supraorbital/temporal"),
    bullet("Stabbing, boring, excruciating pain"),
    bullet("Duration: 15–180 minutes"),
    bullet("Frequency: 1 every 2 days up to 8/day"),
    bullet("Strictly unilateral autonomic features:"),
    subbullet("Ipsilateral lacrimation, conjunctival injection"),
    subbullet("Nasal congestion/rhinorrhoea"),
    subbullet("Miosis and/or ptosis (partial Horner's)"),
    subbullet("Facial sweating, eyelid oedema"),
    bullet("Patient is AGITATED (unlike migraine — prefers stillness)"),
    bullet("Nocturnal attacks common; alcohol triggers during bout"),
    bullet("Cluster periods: weeks to months, then remission"),
    { text: "Hypothalamic (posterior) activation seen on PET/fMRI — hence \"clockwork\" circadian pattern (Harrison's 22E)", options: { fontSize: 10, color: C.midgray, italic: true, breakLine: true } },
  ], { x: 5.25, y: 1.35, w: 4.38, h: 3.8, fontFace: "Calibri", valign: "top" });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – SECTION DIVIDER: DIAGNOSIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Diagnosis & Investigations", "Section 07");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – DIAGNOSIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Diagnosis – History, Examination & Investigations");
  addFooter(s);

  // History
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.25, y: 0.9, w: 4.6, h: 2.0, fill: { color: C.navy }, rectRadius: 0.08, line: { color: C.gold, pt: 1 } });
  s.addText("Key History Points (SOCRATES + Red Flags)", { x: 0.3, y: 0.92, w: 4.5, h: 0.3, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri" });
  s.addText([
    bullet("Site, Onset, Character, Radiation, Associations, Timing, Exacerbating/Relieving factors, Severity", { color: C.white, fontSize: 10.5 }),
    bullet("Previous headache history, family history, medications (analgesic overuse!)", { color: C.white, fontSize: 10.5 }),
    bullet("Aura: visual, sensory, speech changes, duration, march", { color: C.white, fontSize: 10.5 }),
    bullet("Systemic symptoms: fever, weight loss, rash, jaw claudication", { color: C.white, fontSize: 10.5 }),
  ], { x: 0.3, y: 1.22, w: 4.5, h: 1.6, fontFace: "Calibri", valign: "top" });

  // Examination
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.15, y: 0.9, w: 4.6, h: 2.0, fill: { color: C.navy }, rectRadius: 0.08, line: { color: C.teal, pt: 1 } });
  s.addText("Neurological Examination", { x: 5.2, y: 0.92, w: 4.5, h: 0.3, fontSize: 12, bold: true, color: C.gold, fontFace: "Calibri" });
  s.addText([
    bullet("Vital signs: BP, temperature, heart rate", { color: C.white, fontSize: 10.5 }),
    bullet("Fundoscopy: papilloedema → raised ICP", { color: C.white, fontSize: 10.5 }),
    bullet("Meningism: neck stiffness, Kernig's, Brudzinski's → meningitis/SAH", { color: C.white, fontSize: 10.5 }),
    bullet("Focal neurological deficits, cranial nerves, cerebellar signs", { color: C.white, fontSize: 10.5 }),
    bullet("Temporal artery palpation if >50 yrs (GCA)", { color: C.white, fontSize: 10.5 }),
  ], { x: 5.2, y: 1.22, w: 4.5, h: 1.6, fontFace: "Calibri", valign: "top" });

  // Investigations table area
  s.addText("Investigations (when indicated by red flags or clinical suspicion)", {
    x: 0.25, y: 3.0, w: 9.5, h: 0.3, fontSize: 13, bold: true, color: C.indigo, fontFace: "Calibri"
  });

  const invRows = [
    ["CT Head (non-contrast)", "First choice in EMERGENCY: acute thunderclap, trauma, suspected SAH — sens ~98% within 6h (Harrison's 22E)"],
    ["CT Angiography / MR Angiography", "Cerebral aneurysm, arterial dissection, arteriovenous malformation"],
    ["MRI Brain (with gadolinium)", "Superior to CT for posterior fossa, venous thrombosis, leptomeningeal disease, chronic conditions"],
    ["Lumbar Puncture (LP)", "If CT negative and SAH still suspected: xanthochromia up to 2 weeks; also for CSF pressure, meningitis work-up"],
    ["Blood tests", "FBC, ESR, CRP (GCA), glucose, U&E, LFTs; toxicology if substance-related headache"],
    ["EEG", "Only if seizure disorder suspected; not routinely indicated in headache"],
  ];

  invRows.forEach(([test, indication], i) => {
    const y = 3.38 + i * 0.33;
    const fillColor = i % 2 === 0 ? C.lightgray : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y, w: 9.5, h: 0.32, fill: { color: fillColor }, line: { color: C.lightgray } });
    s.addText(test, { x: 0.3, y: y + 0.02, w: 3.0, h: 0.28, fontSize: 10, bold: true, color: C.navy, fontFace: "Calibri", valign: "middle" });
    s.addText(indication, { x: 3.4, y: y + 0.02, w: 6.2, h: 0.28, fontSize: 10, color: C.indigo, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – SECTION DIVIDER: TREATMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Treatment of Headache", "Section 08–10");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 – ACUTE MIGRAINE TREATMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Acute/Abortive Treatment of Migraine (Harrison's 22E)");
  addFooter(s);

  s.addText("General Principle: Treat as early as possible; dose adequately; choose route based on severity", {
    x: 0.25, y: 0.88, w: 9.5, h: 0.28, fontSize: 11, color: C.teal, fontFace: "Calibri", italic: true, bold: true
  });

  const drugRows = [
    { class: "NSAIDs / Analgesics", color: C.indigo, drugs: [
      "Ibuprofen 400–600 mg, Aspirin 1000 mg, Naproxen 500 mg — first-line for mild–moderate attacks",
      "Aspirin + Acetaminophen + Caffeine combination (FDA-approved for mild–moderate migraine)",
      "Ketorolac IM/IV for ED setting",
      "Limitation: less effective in severe attacks; overuse risk (MOH if >10–15 days/month)",
    ]},
    { class: "5-HT₁B/₁D Agonists (Triptans)", color: C.teal, drugs: [
      "Sumatriptan: 50–100 mg oral, 6 mg SC (fastest onset), 20 mg nasal spray",
      "Zolmitriptan, Rizatriptan, Eletriptan, Naratriptan, Almotriptan, Frovatriptan",
      "Mechanism: vasoconstriction of dilated meningeal vessels + inhibit CGRP/SP release",
      "Contraindicated: CAD, stroke, uncontrolled HTN, ergot use within 24h, haemiplegic/basilar migraine",
      "Effective in 50–70% for pain relief; take at headache onset (not aura)",
    ]},
    { class: "CGRP Receptor Antagonists (Gepants)", color: C.navy, drugs: [
      "Rimegepant 75 mg oral ODT, Ubrogepant 50–100 mg oral",
      "No vasoconstriction; safe in cardiovascular disease",
      "Effective for acute attacks AND prevention (unlike triptans)",
      "Repeat dosing at 2h effective (unlike triptans)",
    ]},
    { class: "5-HT₁F Agonists (Ditans)", color: C.red, drugs: [
      "Lasmiditan 50–200 mg — no vasoconstriction, CNS-penetrant",
      "No cardiovascular contraindications; SE: dizziness, sedation",
      "Do not drive 8 hours after use",
    ]},
    { class: "Dopamine Antagonists (antiemetics)", color: C.midgray, drugs: [
      "Metoclopramide, Prochlorperazine, Domperidone — treat nausea AND potentiate analgesics",
      "IV/IM Prochlorperazine highly effective in ED",
      "Chlorpromazine IV: useful in refractory ED migraine",
    ]},
  ];

  drugRows.forEach(({ class: cls, color, drugs }, i) => {
    const y = 1.22 + i * 0.83;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.2, y, w: 1.6, h: 0.78, fill: { color }, line: { color } });
    s.addText(cls, { x: 0.22, y: y + 0.05, w: 1.55, h: 0.68, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.shapes.RECTANGLE, { x: 1.8, y, w: 8.0, h: 0.78, fill: { color: i % 2 === 0 ? C.offwhite : C.white }, line: { color: C.lightgray } });
    const bulletItems = drugs.map((t) => ({ text: "• " + t, options: { breakLine: true, fontSize: 9.8, color: C.navy, fontFace: "Calibri" } }));
    s.addText(bulletItems, { x: 1.85, y: y + 0.03, w: 7.9, h: 0.72, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 – PREVENTIVE TREATMENT OF MIGRAINE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Preventive Treatment of Migraine (Harrison's 22E)");
  addFooter(s);

  // Indication box
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.88, w: 9.6, h: 0.55, fill: { color: C.indigo }, rectRadius: 0.07, line: { color: C.gold, pt: 1 } });
  s.addText("Indications: ≥4 migraine days/month (disabling); attacks not controlled by acute therapy; specific syndromes (hemiplegic, brainstem aura); medication overuse; patient preference", {
    x: 0.3, y: 0.9, w: 9.4, h: 0.48, fontSize: 11, color: C.white, fontFace: "Calibri", italic: true, valign: "middle"
  });

  const preventives = [
    { cat: "Beta-Blockers\n(1st line)", color: C.indigo, info: "Propranolol 40–240 mg/day, Metoprolol 50–200 mg/day, Timolol\n✓ Well-studied; CI: asthma, heart block, depression; may worsen fatigue" },
    { cat: "Anticonvulsants\n(1st line)", color: C.teal, info: "Topiramate 25–100 mg/day, Valproate 500–1500 mg/day\n✓ Topiramate: also weight loss; CI in pregnancy (teratogenic). Valproate: teratogenic (avoid women of child-bearing age)" },
    { cat: "Tricyclic\nAntidepressants", color: C.navy, info: "Amitriptyline 25–75 mg nocte — especially for comorbid insomnia, depression, TTH overlap\n✓ Only proven TTH prevention agent; SE: sedation, dry mouth, weight gain" },
    { cat: "SNRIs", color: C.midgray, info: "Venlafaxine 75–150 mg/day\n✓ Useful if comorbid depression/anxiety; less evidence than TCAs" },
    { cat: "Anti-CGRP\nMonoclonal Abs\n(novel)", color: C.red, info: "Erenumab (anti-CGRP receptor) SC monthly\nFremanezumab, Galcanezumab, Eptinezumab (anti-CGRP ligand)\n✓ ~50% reduction in monthly migraine days in clinical trials; excellent tolerability; once-monthly or quarterly dosing" },
    { cat: "Botulinum\nToxin A", color: C.green, info: "OnabotulinumtoxinA 155–195 U every 12 weeks — for CHRONIC MIGRAINE (≥15 days/month) only\n✓ PREEMPT trials: ~50% responder rate; not effective in episodic migraine" },
    { cat: "Calcium Channel\nBlockers", color: C.teal, info: "Verapamil (mainly cluster prevention), Flunarizine (not available in US)\n✓ Flunarizine well-evidenced in many countries" },
    { cat: "Non-pharma", color: C.indigo, info: "Regular sleep, meals, exercise; stress management; trigger identification & avoidance\nBiofeedback, CBT — as effective as propranolol in RCTs; Transcranial magnetic stimulation (licensed)" },
  ];

  preventives.forEach(({ cat, color, info }, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.2 : 5.1;
    const y = 1.5 + row * 0.98;
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 1.3, h: 0.88, fill: { color }, line: { color } });
    s.addText(cat, { x: x + 0.02, y: y + 0.05, w: 1.26, h: 0.78, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.shapes.RECTANGLE, { x: x + 1.3, y, w: 3.5, h: 0.88, fill: { color: row % 2 === 0 ? C.offwhite : C.white }, line: { color: C.lightgray } });
    s.addText(info, { x: x + 1.35, y: y + 0.03, w: 3.4, h: 0.82, fontSize: 9.5, color: C.navy, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – TREATMENT OF TTH & CLUSTER HEADACHE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Treatment – Tension-Type & Cluster Headache (Harrison's 22E)");
  addFooter(s);

  // TTH side
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.88, w: 4.6, h: 4.38, fill: { color: C.offwhite }, rectRadius: 0.1, line: { color: C.indigo, pt: 2 } });
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 0.88, w: 4.6, h: 0.38, fill: { color: C.indigo }, rectRadius: 0.08, line: { color: C.indigo } });
  s.addText("TENSION-TYPE HEADACHE", { x: 0.25, y: 0.89, w: 4.5, h: 0.34, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  s.addText("Acute", { x: 0.3, y: 1.32, w: 4.35, h: 0.26, fontSize: 11.5, bold: true, color: C.indigo, fontFace: "Calibri" });
  s.addText([
    bullet("Simple analgesics: Paracetamol 1g, Aspirin 600–1000 mg, Ibuprofen 400–600 mg"),
    bullet("Triptans NOT effective for pure TTH (Harrison's 22E)"),
    bullet("Avoid opioids — risk of medication-overuse headache"),
    bullet("Treat early with adequate dose"),
  ], { x: 0.3, y: 1.58, w: 4.35, h: 1.38, fontFace: "Calibri", valign: "top" });

  s.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 3.0, w: 4.0, h: 0.04, fill: { color: C.lightgray }, line: { color: C.lightgray } });

  s.addText("Prevention (Chronic TTH)", { x: 0.3, y: 3.08, w: 4.35, h: 0.26, fontSize: 11.5, bold: true, color: C.indigo, fontFace: "Calibri" });
  s.addText([
    bullet("Amitriptyline 25–75 mg nocte: ONLY proven preventive for chronic TTH"),
    bullet("Other TCAs, SSRIs, benzodiazepines: NOT proven effective"),
    bullet("Acupuncture: insufficient evidence"),
    bullet("OnabotulinumtoxinA: NEGATIVE in chronic TTH trials"),
    bullet("Non-pharmacological: relaxation, biofeedback, stress management — effective adjuncts"),
    bullet("Physiotherapy, regular sleep, pericranial muscle therapy"),
  ], { x: 0.3, y: 3.35, w: 4.35, h: 1.8, fontFace: "Calibri", valign: "top" });

  // Cluster side
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.15, y: 0.88, w: 4.6, h: 4.38, fill: { color: C.offwhite }, rectRadius: 0.1, line: { color: C.red, pt: 2 } });
  s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.15, y: 0.88, w: 4.6, h: 0.38, fill: { color: C.red }, rectRadius: 0.08, line: { color: C.red } });
  s.addText("CLUSTER HEADACHE", { x: 5.2, y: 0.89, w: 4.5, h: 0.34, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  s.addText("Acute Abortive", { x: 5.25, y: 1.32, w: 4.35, h: 0.26, fontSize: 11.5, bold: true, color: C.red, fontFace: "Calibri" });
  s.addText([
    bullet("100% O₂ inhalation 10–15 L/min via non-rebreather mask for 15–20 min (highly effective)"),
    bullet("Sumatriptan 6 mg SC or 20 mg nasal spray — fastest onset"),
    bullet("Zolmitriptan 5 mg nasal spray"),
    bullet("Intranasal lidocaine (4%)"),
    bullet("Ergotamine 2 mg (bedtime anticipatory dosing for nocturnal attacks)"),
  ], { x: 5.25, y: 1.58, w: 4.35, h: 1.4, fontFace: "Calibri", valign: "top" });

  s.addShape(pres.shapes.RECTANGLE, { x: 5.5, y: 3.0, w: 4.0, h: 0.04, fill: { color: C.lightgray }, line: { color: C.lightgray } });

  s.addText("Prevention & Bridging", { x: 5.25, y: 3.08, w: 4.35, h: 0.26, fontSize: 11.5, bold: true, color: C.red, fontFace: "Calibri" });
  s.addText([
    bullet("Verapamil 240–480 mg/day: preferred preventive (ECG monitoring required)"),
    bullet("Lithium 600–900 mg/day: effective in chronic cluster; toxicity risk"),
    bullet("Prednisone (bridging): 75 mg/day tapering — rapid onset, short-term use"),
    bullet("Greater occipital nerve (GON) block: effective bridging therapy"),
    bullet("Galcanezumab (anti-CGRP): reduces cluster frequency by ~50% (Harrison's 22E)"),
    bullet("Surgery: partial trigeminal nerve section for refractory cases (last resort)"),
    bullet("Hypothalamic DBS: for intractable chronic cluster"),
  ], { x: 5.25, y: 3.35, w: 4.35, h: 1.8, fontFace: "Calibri", valign: "top" });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 – SECONDARY HEADACHES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "dark");
  addHeader(s, "Secondary Headaches – Causes & Key Features");
  addFooter(s);

  const secondaries = [
    { name: "Subarachnoid\nHaemorrhage", color: C.red, pts: ["Thunderclap onset (peak <1 min)", "\"Worst headache of life\"", "Meningism, LOC, sentinel bleed", "CT → LP (xanthochromia ≤2 wks)", "Emergency: neurosurgical referral"] },
    { name: "Meningitis /\nEncephalitis", color: "#8E3A59", pts: ["Progressive severe headache + fever", "Neck stiffness, photophobia", "Kernig's / Brudzinski's positive", "Petechial rash (meningococcal)", "LP: cells, protein, glucose, Gram stain"] },
    { name: "Raised Intracranial\nPressure", color: C.indigo, pts: ["Worse on lying/bending/morning", "Papilloedema on fundoscopy", "Vomiting (projectile)", "CN VI palsy (false localising sign)", "Causes: tumour, CVT, idiopathic IH"] },
    { name: "Giant Cell\nArteritis", color: "#8B4513", pts: ["Age >50 (mean 70 yrs)", "Temporal artery tenderness", "Jaw claudication, amaurosis", "ESR >50, CRP elevated", "Temporal artery biopsy; URGENT steroids (sight-saving)"] },
    { name: "CSF Hypotension\n(Low Pressure)", color: C.teal, pts: ["Orthostatic: ↑ upright, ↓ lying", "Post-LP (days after procedure)", "Spontaneous CSF leak", "MRI: meningeal enhancement, brain sag", "Treat: bed rest, caffeine, blood patch"] },
    { name: "Cervicogenic\nHeadache", color: C.midgray, pts: ["Unilateral head pain from neck", "Restricted cervical range of motion", "Confirmed by diagnostic nerve block", "C2/C3 nerve roots implicated", "Treatment: physiotherapy, nerve blocks"] },
  ];

  secondaries.forEach(({ name, color, pts }, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.27;
    const y = 0.92 + row * 2.32;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 3.1, h: 2.18, fill: { color: C.indigo }, rectRadius: 0.08, line: { color, pt: 2 } });
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.1, h: 0.38, fill: { color }, line: { color } });
    s.addText(name, { x: x + 0.05, y: y + 0.02, w: 3.0, h: 0.34, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    const bulletItems = pts.map((t) => ({ text: "• " + t, options: { breakLine: true, fontSize: 10, color: C.lightgray, fontFace: "Calibri" } }));
    s.addText(bulletItems, { x: x + 0.08, y: y + 0.42, w: 2.95, h: 1.7, fontFace: "Calibri", valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 – SUMMARY TABLE: HEADACHE COMPARISON
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideBg(s, "light");
  addHeader(s, "Summary – Comparison of Primary Headache Types");
  addFooter(s);

  const headers = ["Feature", "Migraine", "Tension-Type", "Cluster"];
  const rows = [
    ["Prevalence", "~15% (F > M 3:1)", "~40% (M = F)", "~0.1% (M >> F)"],
    ["Location", "Unilateral (60%) or bilateral", "Bilateral", "Strictly unilateral"],
    ["Quality", "Pulsating/throbbing", "Pressing/tightening (non-pulsatile)", "Stabbing/boring (excruciating)"],
    ["Severity", "Moderate–severe", "Mild–moderate", "Very severe/excruciating"],
    ["Duration", "4–72 hours", "30 min – 7 days", "15–180 minutes"],
    ["Nausea/Vomiting", "Yes (defining feature)", "No", "Rare"],
    ["Photo/Phonophobia", "Both", "One or neither", "Rare"],
    ["Autonomic features", "Absent (typically)", "Absent", "Prominent (ipsilateral)"],
    ["Patient behaviour", "Prefers stillness, quiet, dark", "Can continue activities", "Agitated, restless"],
    ["Acute treatment", "Triptans, NSAIDs, Gepants", "Paracetamol, NSAIDs", "O₂ 100%, SC sumatriptan"],
    ["Prevention", "Beta-blockers, topiramate, anti-CGRP Abs", "Amitriptyline (only)", "Verapamil, lithium"],
  ];

  const colW = [2.05, 2.62, 2.62, 2.42];
  const colX = [0.2, 2.28, 4.93, 7.58];
  const headerColors = [C.navy, C.indigo, C.teal, C.red];

  // Header row
  headers.forEach((h, ci) => {
    s.addShape(pres.shapes.RECTANGLE, { x: colX[ci], y: 0.92, w: colW[ci], h: 0.32, fill: { color: headerColors[ci] }, line: { color: headerColors[ci] } });
    s.addText(h, { x: colX[ci] + 0.04, y: 0.93, w: colW[ci] - 0.08, h: 0.28, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  rows.forEach((row, ri) => {
    const y = 1.26 + ri * 0.38;
    const bg = ri % 2 === 0 ? C.offwhite : C.white;
    row.forEach((cell, ci) => {
      s.addShape(pres.shapes.RECTANGLE, { x: colX[ci], y, w: colW[ci], h: 0.36, fill: { color: ci === 0 ? C.lightgray : bg }, line: { color: C.lightgray } });
      s.addText(cell, { x: colX[ci] + 0.04, y: y + 0.02, w: colW[ci] - 0.08, h: 0.32, fontSize: 9.5, bold: ci === 0, color: ci === 0 ? C.navy : C.indigo, fontFace: "Calibri", valign: "middle" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 22 – FINAL SUMMARY / TAKE-HOME MESSAGES
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: C.gold }, line: { color: C.gold } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.12, w: 0.18, h: 5.5, fill: { color: C.teal }, line: { color: C.teal } });

  s.addText("Key Take-Home Messages", { x: 0.5, y: 0.2, w: 9.2, h: 0.55, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", align: "center", charSpacing: 3 });
  s.addShape(pres.shapes.RECTANGLE, { x: 2.5, y: 0.78, w: 5, h: 0.045, fill: { color: C.gold }, line: { color: C.gold } });

  const takeHome = [
    ["1", "Migraine is a neurological disorder — trigeminovascular activation + CSD + central sensitisation underlie all phases"],
    ["2", "Always screen for RED FLAGS (SNOOP4): thunderclap, fever, focal deficit, papilloedema, age >50, progressive pattern, worst ever"],
    ["3", "ICHD-3 criteria are the diagnostic standard: primary headaches are diagnoses of inclusion, NOT exclusion"],
    ["4", "Acute migraine: triptans ± NSAIDs for moderate–severe; gepants for CV disease; treat early for best efficacy"],
    ["5", "Prevention (≥4 migraine days/month): beta-blockers, topiramate, amitriptyline, anti-CGRP monoclonal antibodies (novel)"],
    ["6", "Cluster headache: 100% O₂ + SC sumatriptan acutely; verapamil for prevention; agitated patient is a hallmark"],
    ["7", "Chronic TTH: amitriptyline is the only proven preventive; triptans do NOT work for pure TTH"],
    ["8", "SAH until proven otherwise in thunderclap headache: CT first, then LP if CT negative (xanthochromia up to 2 weeks)"],
  ];

  takeHome.forEach(([num, msg], i) => {
    const y = 0.92 + i * 0.57;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.35, y, w: 0.38, h: 0.44, fill: { color: C.gold }, rectRadius: 0.05, line: { color: C.gold } });
    s.addText(num, { x: 0.35, y: y + 0.02, w: 0.38, h: 0.4, fontSize: 14, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(msg, { x: 0.82, y: y + 0.05, w: 8.85, h: 0.38, fontSize: 11.5, color: C.white, fontFace: "Calibri", valign: "middle" });
  });

  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.4, w: 10, h: 0.225, fill: { color: C.indigo }, line: { color: C.indigo } });
  s.addText("Sources: Harrison's Principles of Internal Medicine 22E (2025) | Adams and Victor's Principles of Neurology 12E | ICHD-3 Classification", {
    x: 0.2, y: 5.41, w: 9.6, h: 0.2, fontSize: 7.5, color: C.midgray, fontFace: "Calibri", align: "center", italic: true, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/headache-pptx/Headache_Neurology_Harrison.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/headache-pptx/Headache_Neurology_Harrison.pptx"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Fetch images as base64 ─────────────────────────────────────────────────
const imageUrls = [
  "https://neurotorium.org/cdn-cgi/image/format=auto,quality=85,metadata=none/wp-content/uploads/fig-3-trigeminovascular-system-and-migraine-1360x961.jpg",
  "https://upload.wikimedia.org/wikipedia/commons/3/37/ScintillatingScotoma3.jpg",
  "https://upload.wikimedia.org/wikipedia/commons/thumb/b/b0/Migraine_aura.jpg/1280px-Migraine_aura.jpg",
  "https://www.mayoclinic.org/-/media/kcms/gbs/patient-consumer/images/2019/03/14/20/11/cluster-headache-8col-3802786-007-0.jpg",
  "https://medlineplus.gov/ency/images/ency/fullsize/19241.jpg",
  "https://neurotorium.org/wp-content/uploads/a-model-of-migraine-pathophysiology-2.png",
];

let images = [];
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(raw);
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imageUrls.map(url => ({ url, base64: null, error: e.message }));
}

function img(idx) {
  return images[idx] && !images[idx].error ? images[idx].base64 : null;
}

// ─── Color palette ─────────────────────────────────────────────────────────
const DARK    = "0D1B2A"; // Deep navy
const MID     = "1B4F72"; // Steel blue
const ACCENT  = "E74C3C"; // Red accent
const LIGHT   = "D6EAF8"; // Pale blue
const WHITE   = "FFFFFF";
const GRAY    = "BDC3C7";
const GOLD    = "F39C12"; // Amber highlight

// ─── Helpers ────────────────────────────────────────────────────────────────
function addDarkSlide(pres, title) {
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  return slide;
}
function addLightSlide(pres) {
  const slide = pres.addSlide();
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  return slide;
}
function sideBar(slide, color) {
  slide.addShape(slide._slideObject ? null : "rect", { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: color || ACCENT } });
}
function slideTitle(slide, text, opts) {
  slide.addText(text, {
    x: 0.3, y: 0.15, w: 9.4, h: 0.7,
    fontSize: 28, bold: true, color: WHITE,
    fontFace: "Calibri", margin: 0,
    ...(opts || {})
  });
}
function bodyBullets(slide, items, opts) {
  const bullets = items.map((t, i) => ({
    text: t,
    options: { bullet: true, breakLine: i < items.length - 1, fontSize: 17, color: DARK, fontFace: "Calibri" }
  }));
  slide.addText(bullets, {
    x: 0.4, y: 1.0, w: 9.2, h: 4.3,
    valign: "top",
    ...(opts || {})
  });
}

// ═══════════════════════════════════════════════════════════════════════════
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Headache: A Clinical Overview";
pres.author = "Based on Harrison's Principles & Bradley-Daroff Neurology";

// ─── SLIDE 1: Title ─────────────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.08, fill: { color: ACCENT } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.545, w: "100%", h: 0.08, fill: { color: ACCENT } });
  sl.addText("HEADACHE", {
    x: 0.5, y: 1.1, w: 9, h: 1.4,
    fontSize: 60, bold: true, color: WHITE,
    fontFace: "Calibri", align: "center", charSpacing: 8
  });
  sl.addText("A Comprehensive Clinical Overview", {
    x: 0.5, y: 2.55, w: 9, h: 0.6,
    fontSize: 22, color: GOLD, fontFace: "Calibri", align: "center", italic: true
  });
  sl.addShape(pres.ShapeType.rect, { x: 2.5, y: 3.3, w: 5, h: 0.04, fill: { color: ACCENT } });
  sl.addText("Reference: Harrison's Principles of Internal Medicine\n& Bradley and Daroff's Neurology in Clinical Practice", {
    x: 0.5, y: 3.5, w: 9, h: 0.8,
    fontSize: 14, color: GRAY, fontFace: "Calibri", align: "center"
  });
}

// ─── SLIDE 2: Definition & Classification ───────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Definition & Classification", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Two boxes
  const box = (x, y, w, h, title, color, textItems) => {
    sl.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color }, line: { color: "CCCCCC", pt: 0 }, shadow: { type: "outer", blur: 4, offset: 2, angle: 45, color: "AAAAAA", opacity: 0.2 } });
    sl.addText(title, { x: x + 0.1, y: y + 0.08, w: w - 0.2, h: 0.4, fontSize: 15, bold: true, color: DARK, fontFace: "Calibri", margin: 0 });
    const items = textItems.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < textItems.length - 1, fontSize: 13, color: DARK, fontFace: "Calibri" } }));
    sl.addText(items, { x: x + 0.1, y: y + 0.5, w: w - 0.2, h: h - 0.6, valign: "top" });
  };

  box(0.25, 1.05, 4.5, 2.2, "PRIMARY HEADACHES (ICHD-3)", LIGHT, [
    "Migraine (with & without aura)",
    "Tension-type headache",
    "Cluster headache & TACs",
    "Other primary headaches"
  ]);
  box(5.0, 1.05, 4.5, 2.2, "SECONDARY HEADACHES", LIGHT, [
    "Attributed to trauma/injury",
    "Attributed to vascular disorders",
    "Attributed to infection",
    "Attributed to substance/withdrawal"
  ]);
  box(0.25, 3.4, 9.25, 1.8, "Red Flag Symptoms (SNOOP4)", "FFF3CD", [
    "Systemic symptoms (fever, weight loss) | Neurologic signs | Onset sudden (thunderclap)",
    "Older onset (>50 yrs) | Pattern change | Postural worsening | Papilledema",
    "Precipitated by Valsalva | Progressive worsening"
  ]);
}

// ─── SLIDE 3: Epidemiology ───────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Epidemiology", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const stat = (x, y, value, label, color) => {
    sl.addShape(pres.ShapeType.rect, { x, y, w: 2.8, h: 1.7, fill: { color }, roundedCorners: true });
    sl.addText(value, { x, y: y + 0.15, w: 2.8, h: 0.9, fontSize: 38, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    sl.addText(label, { x, y: y + 1.0, w: 2.8, h: 0.55, fontSize: 12, color: WHITE, fontFace: "Calibri", align: "center" });
  };
  stat(0.25, 1.05, "~15%", "1-year migraine prevalence (Global Burden of Disease)", MID);
  stat(3.4, 1.05, "3:1", "Female:Male ratio for migraine", "1A5276");
  stat(6.6, 1.05, "~40%", "Familial occurrence in migraine with aura", "7B241C");

  sl.addText("Key Epidemiological Facts", {
    x: 0.25, y: 2.95, w: 9.25, h: 0.4,
    fontSize: 16, bold: true, color: GOLD, fontFace: "Calibri"
  });
  const bullets = [
    "Migraine: onset predominantly before age 30; most common in women aged 25–55",
    "Tension-type headache: most common headache type; higher in women; arises in middle age",
    "Cluster headache: prevalence ~1/500; male predominance (3:1); onset 3rd decade of life",
    "1/3 of migraineurs have >3 attacks/month if untreated; significant disability and healthcare burden"
  ].map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < 3, fontSize: 14, color: WHITE, fontFace: "Calibri" } }));
  sl.addText(bullets, { x: 0.3, y: 3.35, w: 9.2, h: 2.0, valign: "top" });
}

// ─── SLIDE 4: Migraine – Clinical Features ──────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Migraine: Clinical Features", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });
  const leftBullets = [
    "Periodic, unilateral (or bilateral) pulsatile headache",
    "Often begins in childhood/adolescence; onset <30 yrs in >80%",
    "Nausea ± vomiting; photophobia; phonophobia; osmophobia",
    "Pain intensified by movement; prefers dark, quiet room",
    "Migraine WITHOUT aura (common): unheralded onset over minutes",
    "Migraine WITH aura (classic): preceded by visual/sensory/speech disturbance"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 14, color: DARK, fontFace: "Calibri" } }));
  sl.addText(leftBullets, { x: 0.3, y: 1.0, w: 5.2, h: 3.8, valign: "top" });

  // Aura image
  const auraImg = img(2); // migraine_aura.jpg
  if (auraImg) {
    sl.addImage({ data: auraImg, x: 5.7, y: 1.0, w: 3.9, h: 2.4 });
    sl.addText("Migraine aura – scintillating scotoma\n(Source: Wikimedia Commons)", {
      x: 5.7, y: 3.4, w: 3.9, h: 0.5,
      fontSize: 9, color: "666666", fontFace: "Calibri", italic: true, align: "center"
    });
  } else {
    sl.addShape(pres.ShapeType.rect, { x: 5.7, y: 1.0, w: 3.9, h: 2.4, fill: { color: LIGHT } });
    sl.addText("Migraine Aura\n(Visual Disturbance)", { x: 5.7, y: 1.9, w: 3.9, h: 0.6, fontSize: 13, color: MID, align: "center", fontFace: "Calibri", italic: true });
  }

  // Phases bar
  const phases = ["Prodrome\n(hrs-days)", "Aura\n(20-30 min)", "Headache\n(4-72 hrs)", "Postdrome\n(hrs-days)"];
  const phaseColors = ["1A5276", MID, ACCENT, "7D6608"];
  phases.forEach((p, i) => {
    sl.addShape(pres.ShapeType.rect, { x: 0.3 + i * 2.35, y: 4.9, w: 2.2, h: 0.6, fill: { color: phaseColors[i] } });
    sl.addText(p, { x: 0.3 + i * 2.35, y: 4.9, w: 2.2, h: 0.6, fontSize: 11, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
  });
  sl.addText("Phases of a Migraine Attack", { x: 0.3, y: 4.72, w: 9.4, h: 0.25, fontSize: 11, bold: true, color: DARK, fontFace: "Calibri" });
}

// ─── SLIDE 5: Migraine Aura ──────────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: "7B241C" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: GOLD } });
  sl.addText("Migraine Aura & Visual Phenomena", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const scotImg = img(1); // ScintillatingScotoma
  if (scotImg) {
    sl.addImage({ data: scotImg, x: 0.3, y: 1.0, w: 4.5, h: 3.2 });
    sl.addText("Scintillating scotoma – typical migraine aura\n(Source: Wikimedia Commons)", {
      x: 0.3, y: 4.2, w: 4.5, h: 0.5,
      fontSize: 9, color: GRAY, fontFace: "Calibri", italic: true, align: "center"
    });
  }

  const bullets = [
    "Aura precedes headache by minutes; resolves before or as headache begins",
    "Most common: visual – scintillating scotoma, fortification spectra, photopsia",
    "Sensory aura: unilateral paresthesias spreading over minutes (cheiro-oral pattern)",
    "Motor aura: dysphasia or hemiparesis (hemiplegic migraine)",
    "Spreads at 2-3 mm/min – correlates with cortical spreading depression (CSD)",
    "CSD: wave of neuronal/glial depolarization described by Leão; moves ~3 mm/min",
    "Aura:Headache ratio approximately 1:5 (with:without aura)"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 13.5, color: WHITE, fontFace: "Calibri" } }));
  sl.addText(bullets, { x: 5.0, y: 1.0, w: 4.8, h: 4.4, valign: "top" });
}

// ─── SLIDE 6: Pathogenesis of Migraine ──────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: GOLD } });
  sl.addText("Pathogenesis of Migraine", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const tvImg = img(5); // trigeminovascular
  if (tvImg) {
    sl.addImage({ data: tvImg, x: 5.5, y: 1.0, w: 4.2, h: 3.0 });
    sl.addText("Trigeminovascular pathway & migraine mechanisms\n(Source: neurotorium.org)", {
      x: 5.5, y: 4.0, w: 4.2, h: 0.5,
      fontSize: 9, color: "666666", fontFace: "Calibri", italic: true, align: "center"
    });
  }

  const bullets = [
    "Genetic basis: polygenic risk; ~40 susceptibility loci; ion channel genes",
    "Cortical Spreading Depression (CSD): wave of depolarization at 2-3 mm/min → aura",
    "Trigeminovascular hypothesis (Moskowitz): activation of trigeminal afferents innervating dura/meningeal vessels",
    "Release of CGRP, substance P from trigeminal endings → neurogenic inflammation",
    "Central sensitization: sensitization of 2nd-order neurons → allodynia",
    "Serotonin (5-HT) dysregulation: triptans are 5-HT1B/1D agonists → vasoconstriction + inhibit CGRP release",
    "Wolff's original vascular hypothesis (extracranial artery dilation) now largely revised"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 13, color: DARK, fontFace: "Calibri" } }));
  sl.addText(bullets, { x: 0.3, y: 1.0, w: 5.0, h: 4.4, valign: "top" });
}

// ─── SLIDE 7: Tension-Type Headache ─────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: "1D6A96" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Tension-Type Headache", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Compare table
  const headers = ["Feature", "Tension-Type", "Migraine"];
  const rows = [
    ["Location", "Bilateral (band-like)", "Unilateral (or bilateral)"],
    ["Quality", "Dull, pressing/tightening", "Pulsating/throbbing"],
    ["Severity", "Mild to moderate", "Moderate to severe"],
    ["Nausea/Vomiting", "Absent", "Common"],
    ["Photo/Phonophobia", "Absent (or 1 only)", "Both present"],
    ["Activity effect", "Not aggravated", "Worsened by activity"],
    ["Duration", "30 min – 7 days (hours to years)", "4 – 72 hours"],
  ];
  const colW = [2.2, 3.4, 3.4];
  const colX = [0.25, 2.55, 6.05];
  const hColors = [DARK, "1A5276", "7B241C"];
  headers.forEach((h, c) => {
    sl.addShape(pres.ShapeType.rect, { x: colX[c], y: 1.0, w: colW[c], h: 0.45, fill: { color: hColors[c] } });
    sl.addText(h, { x: colX[c], y: 1.0, w: colW[c], h: 0.45, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
  });
  rows.forEach((row, r) => {
    const bg = r % 2 === 0 ? "1B2A38" : "162330";
    row.forEach((cell, c) => {
      sl.addShape(pres.ShapeType.rect, { x: colX[c], y: 1.5 + r * 0.5, w: colW[c], h: 0.48, fill: { color: bg } });
      sl.addText(cell, { x: colX[c] + 0.05, y: 1.5 + r * 0.5, w: colW[c] - 0.1, h: 0.48, fontSize: 12, color: r === 0 ? GOLD : WHITE, fontFace: "Calibri", valign: "middle" });
    });
  });
  sl.addText("Note: Chronic tension-type headache can persist for years; anxiety and depression are present in most patients (Bradley-Daroff Neurology)", {
    x: 0.25, y: 5.0, w: 9.5, h: 0.5,
    fontSize: 11, color: GRAY, fontFace: "Calibri", italic: true
  });
}

// ─── SLIDE 8: Cluster Headache ──────────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: "7B241C" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: MID } });
  sl.addText("Cluster Headache", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const clImg = img(3); // cluster-headache mayo
  if (clImg) {
    sl.addImage({ data: clImg, x: 6.0, y: 1.0, w: 3.65, h: 2.6 });
    sl.addText("Cluster headache – unilateral periorbital pain\n(Source: Mayo Clinic)", {
      x: 6.0, y: 3.6, w: 3.65, h: 0.5,
      fontSize: 9, color: "666666", fontFace: "Calibri", italic: true, align: "center"
    });
  }

  const bullets = [
    "Most painful recurrent headache known",
    "Episodic: clusters 7 days–1 year; remission ≥3 months",
    "Chronic: >1 year without remission (10% of cases)",
    "Attacks: 1-3/day, 15 min–3 hrs; nocturnal onset common",
    "Onset: 3rd decade; male:female ~3:1; prevalence ~1/500",
    "Ipsilateral autonomic: lacrimation, ptosis, miosis, rhinorrhea, conjunctival injection",
    "Periodicity is cardinal feature – striking circadian regularity",
    "Familial risk: 18× in 1st-degree relatives (autosomal dominant, variable penetrance)"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 13, color: DARK, fontFace: "Calibri" } }));
  sl.addText(bullets, { x: 0.3, y: 1.0, w: 5.5, h: 4.6, valign: "top" });
}

// ─── SLIDE 9: Other Primary Headaches ───────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: GOLD } });
  sl.addText("Other Primary Headache Disorders", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const boxes = [
    { t: "Thunderclap Headache", x: 0.25, y: 1.0, c: "1B2A38", desc: "Severe headache reaching maximum within 1 min; exclude SAH (LP, CT); majority are primary (reversible cerebral vasoconstriction syndrome, RCVS)" },
    { t: "Hypnic Headache", x: 5.0, y: 1.0, c: "1B2A38", desc: "Dull headache awakening from sleep, usually >50 yrs; 15–30 min duration; responds to caffeine or lithium" },
    { t: "Primary Cough Headache", x: 0.25, y: 2.8, c: "1B2A38", desc: "Sudden bilateral head pain on coughing/straining; <1 min; exclude Chiari malformation (50% have secondary cause)" },
    { t: "Primary Exercise Headache", x: 5.0, y: 2.8, c: "1B2A38", desc: "Pulsatile headache during/after physical exertion; 5 min–48 hrs; exclude SAH, arterial dissection" },
    { t: "Primary Stabbing Headache", x: 0.25, y: 4.5, c: "1B2A38", desc: "Transient stabs/jabs, seconds duration; extratrigeminal location; no autonomic features; indomethacin-responsive" },
    { t: "Cold-Stimulus Headache", x: 5.0, y: 4.5, c: "1B2A38", desc: "'Brain freeze'; frontal headache after cold stimulus to palate/pharynx or cold environment; resolves within 30 min" },
  ];
  boxes.forEach(b => {
    sl.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: 4.5, h: 1.65, fill: { color: b.c } });
    sl.addText(b.t, { x: b.x + 0.1, y: b.y + 0.08, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 });
    sl.addText(b.desc, { x: b.x + 0.1, y: b.y + 0.43, w: 4.3, h: 1.1, fontSize: 11, color: WHITE, fontFace: "Calibri" });
  });
}

// ─── SLIDE 10: Medication Overuse Headache ───────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: ACCENT } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: MID } });
  sl.addText("Medication Overuse Headache (MOH)", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const bullets = [
    "Overuse of acute medications → chronic daily headache syndrome (≥15 days/month)",
    "Previously: 'rebound headache'; now classified as MOH (ICHD-3)",
    "Risk (highest→lowest): Opioids/butalbital > Triptans > NSAIDs",
    "Latency: Triptans ~1.7 yrs; Ergots ~2.7 yrs; Analgesics ~4.8 yrs",
    "Pathogenesis: central trigeminal sensitization via impaired descending inhibition (RVM/NRD imbalance)",
    "Population prevalence of CDH with MOH: ~1.4%",
    "Treatment: taper/withdraw offending medication; bridge therapy; preventive agents",
    "Prevention: limit acute treatment to <10–15 days/month (ICHD-3 threshold)"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 14, color: DARK, fontFace: "Calibri" } }));
  sl.addText(bullets, { x: 0.3, y: 1.0, w: 9.2, h: 4.4, valign: "top" });

  sl.addText("Reference: Bradley and Daroff's Neurology in Clinical Practice, MOH section", {
    x: 0.3, y: 5.1, w: 9.4, h: 0.35,
    fontSize: 10, color: "888888", fontFace: "Calibri", italic: true
  });
}

// ─── SLIDE 11: Secondary Headaches & Red Flags ───────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: ACCENT } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: GOLD } });
  sl.addText("Secondary Headaches & Red Flags", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  const categories = [
    { title: "Subarachnoid Hemorrhage", items: ["'Worst headache of life' / thunderclap onset", "Meningism, photophobia, vomiting", "Sentinel leak may precede major bleed", "CT then LP if CT negative"] },
    { title: "Meningitis / Encephalitis", items: ["Fever + headache + meningism = emergency", "Photophobia, altered consciousness", "Kernig/Brudzinski signs", "LP after CT (if no papilledema)"] },
    { title: "Space-Occupying Lesion", items: ["Progressive, positional, morning headache", "Associated neurologic deficits", "Papilledema on fundoscopy", "MRI with contrast required"] },
    { title: "Giant Cell Arteritis", items: ["Age >50; ESR elevated", "Temporal artery tenderness/nodularity", "Jaw claudication, visual loss risk", "Urgent steroids; temporal artery biopsy"] },
  ];
  categories.forEach((cat, i) => {
    const x = (i % 2) * 4.8 + 0.25;
    const y = Math.floor(i / 2) * 2.2 + 1.0;
    sl.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 2.0, fill: { color: "1B2A38" } });
    sl.addText(cat.title, { x: x + 0.1, y: y + 0.05, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 });
    const items = cat.items.map((t, j) => ({ text: t, options: { bullet: true, breakLine: j < cat.items.length - 1, fontSize: 11.5, color: WHITE, fontFace: "Calibri" } }));
    sl.addText(items, { x: x + 0.1, y: y + 0.43, w: 4.3, h: 1.4, valign: "top" });
  });
}

// ─── SLIDE 12: Diagnosis & Workup ───────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: MID } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Diagnosis & Investigations", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Flow diagram
  const step = (x, y, w, h, text, color, tColor) => {
    sl.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color }, roundedCorners: true });
    sl.addText(text, { x, y, w, h, fontSize: 12, bold: true, color: tColor || WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
  };
  const arrow = (x, y) => sl.addShape(pres.ShapeType.triangle, { x, y, w: 0.25, h: 0.2, fill: { color: DARK }, rotate: 180 });

  step(0.25, 1.0, 9.2, 0.55, "Detailed History: character, onset, location, duration, associated symptoms, triggers, family history", MID);
  arrow(4.88, 1.58);
  step(0.25, 1.8, 9.2, 0.55, "Physical Exam: vital signs, fundoscopy, cranial nerve exam, meningeal signs, neurological status", "1A5276");
  arrow(4.88, 2.38);

  // Two paths
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 2.6, w: 4.4, h: 1.5, fill: { color: "D5F5E3" }, line: { color: "27AE60", pt: 2 } });
  sl.addText("No Red Flags Present", { x: 0.25, y: 2.6, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: "27AE60", fontFace: "Calibri", align: "center" });
  sl.addText([
    { text: "Clinical diagnosis (migraine/TTH/cluster)", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK, fontFace: "Calibri" } },
    { text: "Neuroimaging NOT routinely required", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK, fontFace: "Calibri" } },
    { text: "Consider headache diary; ICHD-3 criteria", options: { bullet: true, fontSize: 12, color: DARK, fontFace: "Calibri" } }
  ], { x: 0.35, y: 2.95, w: 4.2, h: 1.1, valign: "top" });

  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 2.6, w: 4.4, h: 1.5, fill: { color: "FADBD8" }, line: { color: ACCENT, pt: 2 } });
  sl.addText("Red Flags Present", { x: 5.1, y: 2.6, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", align: "center" });
  sl.addText([
    { text: "MRI brain ± gadolinium (preferred)", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK, fontFace: "Calibri" } },
    { text: "CT for acute SAH (thunderclap)", options: { bullet: true, breakLine: true, fontSize: 12, color: DARK, fontFace: "Calibri" } },
    { text: "LP if CT negative + SAH suspected", options: { bullet: true, fontSize: 12, color: DARK, fontFace: "Calibri" } }
  ], { x: 5.2, y: 2.95, w: 4.2, h: 1.1, valign: "top" });

  sl.addText("Bradley-Daroff: 'Headaches with sudden onset, progressive frequency/severity, worst ever, focal deficit, or fever require imaging'", {
    x: 0.25, y: 4.2, w: 9.4, h: 0.55,
    fontSize: 11, color: "555555", fontFace: "Calibri", italic: true
  });

  // Labs box
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 4.8, w: 9.2, h: 0.65, fill: { color: LIGHT } });
  sl.addText("Additional Labs (if secondary cause suspected): ESR/CRP (GCA), CBC, metabolic panel, coagulation, CSF analysis, toxicology screen", {
    x: 0.35, y: 4.85, w: 9.0, h: 0.55, fontSize: 12, color: DARK, fontFace: "Calibri"
  });
}

// ─── SLIDE 13: Treatment of Migraine ────────────────────────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: DARK } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: "1A5276" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: ACCENT } });
  sl.addText("Treatment of Migraine", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Acute treatment box
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.98, w: 4.5, h: 2.6, fill: { color: "1B2A38" } });
  sl.addText("ACUTE / ABORTIVE", { x: 0.25, y: 0.98, w: 4.5, h: 0.4, fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", valign: "middle" });
  const acute = [
    "Mild-moderate: NSAIDs (aspirin, ibuprofen, naproxen)",
    "Acetaminophen ± antiemetic (metoclopramide)",
    "Severe: Triptans (5-HT1B/1D agonists) — sumatriptan, zolmitriptan, rizatriptan",
    "SC route fastest; nasal/oral for early use during aura",
    "DHE (dihydroergotamine): effective, but vasoconstriction risk",
    "Antiemetics: prochlorperazine, ondansetron (IV for ED)"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 11.5, color: WHITE, fontFace: "Calibri" } }));
  sl.addText(acute, { x: 0.35, y: 1.4, w: 4.3, h: 2.1, valign: "top" });

  // Preventive box
  sl.addShape(pres.ShapeType.rect, { x: 5.0, y: 0.98, w: 4.7, h: 2.6, fill: { color: "1B2A38" } });
  sl.addText("PREVENTIVE (Prophylactic)", { x: 5.0, y: 0.98, w: 4.7, h: 0.4, fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", valign: "middle" });
  const prev = [
    "Indicated: ≥4 attacks/month or significant disability",
    "Beta-blockers: propranolol, metoprolol (1st line)",
    "TCAs: amitriptyline (benefit even without depression)",
    "Anti-epileptics: valproate, topiramate",
    "CGRP monoclonal antibodies: erenumab, fremanezumab (newer; highly effective)",
    "Botulinum toxin A (for chronic migraine ≥15 days/month)"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 11.5, color: WHITE, fontFace: "Calibri" } }));
  sl.addText(prev, { x: 5.1, y: 1.4, w: 4.5, h: 2.1, valign: "top" });

  // Lifestyle
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.7, w: 9.5, h: 1.65, fill: { color: "162230" } });
  sl.addText("NON-PHARMACOLOGICAL", { x: 0.25, y: 3.7, w: 9.5, h: 0.35, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "center", valign: "middle" });
  const nonpharm = [
    "Identify and avoid triggers (sleep irregularity, stress, hormonal changes, dietary factors, bright lights)",
    "Regular sleep schedule; stress management; biofeedback; cognitive-behavioral therapy (CBT)",
    "Headache diary to track patterns; limit caffeine; adequate hydration; regular meals"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 12, color: WHITE, fontFace: "Calibri" } }));
  sl.addText(nonpharm, { x: 0.35, y: 4.08, w: 9.3, h: 1.2, valign: "top" });
}

// ─── SLIDE 14: Treatment of Cluster & Tension Headaches ─────────────────────
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: "F0F4F8" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.9, fill: { color: "7B241C" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: "100%", fill: { color: MID } });
  sl.addText("Treatment: Cluster & Tension-Type Headaches", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.65,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });

  // Cluster - Acute
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  const clAcute = [
    "100% O₂ inhalation (7-15 L/min × 15 min) – first line",
    "SC sumatriptan 6 mg – rapid and highly effective",
    "Intranasal zolmitriptan / lidocaine",
    "DHE IV/IM for refractory attacks"
  ].map((t, i, arr) => ({ text: t, options: { bullet: true, breakLine: i < arr.length - 1, fontSize: 12, color: DARK, fontFace: "Calibri" } }));
  sl.addText(clAcute, { x: 0.35, y: 1.38, w: 4.3, h: 1.45, valign: "top" });

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  const clPrev = [
    "Verapamil: drug of choice for prevention",
    "Short-course corticosteroids to break clusters",
    "Lithium carbonate for chronic cluster",
    "CGRP mAbs: ~50% reduction in weekly attacks (galcanezumab)"
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  const tensionAcute = [
    "Simple analgesics: aspirin, paracetamol, ibuprofen",
    "Avoid opioids / butalbital (risk of MOH)",
    "Caffeine combination may improve efficacy"
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  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.4, w: 4.5, h: 1.5, fill: { color: LIGHT }, line: { color: MID, pt: 1 } });
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  sl.addText(tensionAcute, { x: 0.35, y: 3.72, w: 4.3, h: 1.1, valign: "top" });

  const tensionPrev = [
    "Amitriptyline (TCA) – effective even without depression",
    "Stress management, biofeedback, CBT",
    "Regular sleep schedule; physical therapy; relaxation techniques"
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  sl.addText(tensionPrev, { x: 5.1, y: 3.72, w: 4.5, h: 1.1, valign: "top" });
}

// ─── SLIDE 15: Summary & Key Takeaways ──────────────────────────────────────
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  });

  const takeaways = [
    ["1", "ICHD-3 classifies headaches into primary (migraine, TTH, cluster) and secondary; red flags mandate urgent workup"],
    ["2", "Migraine affects ~15% globally; trigeminovascular activation + CGRP release + cortical spreading depression are central mechanisms"],
    ["3", "Triptans (5-HT1B/1D agonists) remain cornerstone for acute migraine; CGRP mAbs are transforming prevention"],
    ["4", "Cluster headache = most painful recurrent headache; 100% O₂ + SC sumatriptan for acute attacks; verapamil for prevention"],
    ["5", "MOH is underdiagnosed; limit acute analgesic use; opioids and butalbital carry highest rebound risk"],
    ["6", "Thunderclap headache demands immediate SAH exclusion; CT then LP; imaging for all headache red flags"],
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}

// ─── Write File ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/headache-pptx/Headache_Clinical_Overview.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "Headache - Definition";

// ── Palette ──────────────────────────────────────────────────────────────────
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const NAVY   = "1B4F72";
const STEEL  = "1A5276";
const ACCENT = "E74C3C";
const GOLD   = "F39C12";
const LIGHT  = "D6EAF8";
const WHITE  = "FFFFFF";
const GRAY   = "BDC3C7";

// ── Helper: make a definition card ──────────────────────────────────────────
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// ════════════════════════════════════════════════════════════════════════════
const sl = pres.addSlide();

// ── Full background ──────────────────────────────────────────────────────────
sl.addShape(pres.ShapeType.rect, {
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// ── Left sidebar accent ──────────────────────────────────────────────────────
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// ── Header band ─────────────────────────────────────────────────────────────
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// ── Slide title ──────────────────────────────────────────────────────────────
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// ── Reference badge ──────────────────────────────────────────────────────────
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  align: "center", valign: "middle",
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// ── MASTER DEFINITION BOX ────────────────────────────────────────────────────
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// ── 4 definition cards (2×2 grid) ───────────────────────────────────────────

// Card 1 – Migraine
card(
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    "Worsened by routine activity; lasts 4–72 hours",
    "Associated with nausea/vomiting, photophobia, phonophobia",
    "May occur with aura (visual, sensory, motor, language) or without",
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    "Mild-to-moderate bilateral ('holocranial') pressing/tightening pain",
    "No nausea or vomiting; NOT worsened by activity",
    "Photophobia OR phonophobia — but not both simultaneously",
    "Most common headache type; more prevalent in women",
    "Episodic (<15 days/month) or chronic (≥15 days/month)",
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    "Trigeminal autonomic cephalalgias (TACs): unilateral + ipsilateral autonomic features",
    "Cluster: most painful recurrent headache; strictly unilateral; behind/around the eye",
    "Ipsilateral lacrimation, conjunctival injection, rhinorrhea, ptosis, miosis",
    "Prevalence 56–401/100,000; male predominance (3:1); onset 20–30 yrs",
    "Paroxysmal hemicrania & SUNCT are rarer TAC subtypes",
  ]
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    "PRIMARY: headache IS the disorder — no underlying structural disease (migraine, TTH, cluster)",
    "SECONDARY: headache is a SYMPTOM of an identifiable underlying cause (SAH, infection, SOL, GCA)",
    "ICHD-3 (2018): 3 main groups + appendix; guides diagnosis worldwide",
    "Pain-sensitive structures: circle of Willis branches, dural arteries, venous sinuses, CN V/VII/IX/X",
    "Cranial nerves & C1–C3 roots transmit pain from intracranial & extracranial structures",
  ]
);

// ── Footer ───────────────────────────────────────────────────────────────────
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// ════════════════════════════════════════════════════════════════════════════
pres
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