from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

# ── Colours ──────────────────────────────────────────────────────────────────
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
NAVY       = RGBColor(0x1A, 0x3A, 0x5C)   # deep navy – headings / accent bar
MID_BLUE   = RGBColor(0x2E, 0x74, 0xB5)   # body bullet accent
LIGHT_GREY = RGBColor(0xF2, 0xF2, 0xF2)   # section-divider bg
DARK_GREY  = RGBColor(0x40, 0x40, 0x40)   # body text

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)

blank = prs.slide_layouts[6]   # fully blank – we place everything

# ── Helper: coloured rectangle ───────────────────────────────────────────────
def add_rect(slide, x, y, w, h, colour):
    from pptx.util import Inches, Pt
    shape = slide.shapes.add_shape(
        1,  # MSO_SHAPE_TYPE.RECTANGLE
        Inches(x), Inches(y), Inches(w), Inches(h)
    )
    shape.fill.solid()
    shape.fill.fore_color.rgb = colour
    shape.line.fill.background()
    return shape

# ── Helper: textbox ──────────────────────────────────────────────────────────
def add_textbox(slide, text, x, y, w, h,
                font_name="Calibri", size=18, bold=False,
                colour=DARK_GREY, align=PP_ALIGN.LEFT,
                wrap=True, italic=False):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left  = Pt(0)
    tf.margin_right = Pt(0)
    tf.margin_top   = Pt(0)
    tf.margin_bottom= Pt(0)
    p  = tf.paragraphs[0]
    p.alignment = align
    r  = p.add_run()
    r.text = text
    r.font.name  = font_name
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic= italic
    r.font.color.rgb = colour
    return tf

# ── Helper: multi-bullet textbox ─────────────────────────────────────────────
def add_bullets(slide, items, x, y, w, h,
                font_name="Calibri", size=16,
                colour=DARK_GREY, line_spacing_pt=None):
    from pptx.oxml.ns import qn
    from lxml import etree
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left   = Pt(4)
    tf.margin_right  = Pt(0)
    tf.margin_top    = Pt(2)
    tf.margin_bottom = Pt(2)
    first = True
    for item in items:
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(4)
        bullet_char = "•  "
        r = p.add_run()
        r.text = bullet_char + item
        r.font.name  = font_name
        r.font.size  = Pt(size)
        r.font.color.rgb = colour
    return tf

# ── Helper: section divider slide ────────────────────────────────────────────
def section_slide(title_text, subtitle_text=""):
    slide = prs.slides.add_slide(blank)
    # Full navy background
    add_rect(slide, 0, 0, 13.333, 7.5, NAVY)
    # Centre title
    add_textbox(slide, title_text, 1.0, 2.8, 11.333, 1.2,
                size=40, bold=True, colour=WHITE, align=PP_ALIGN.CENTER)
    if subtitle_text:
        add_textbox(slide, subtitle_text, 1.0, 4.15, 11.333, 0.8,
                    size=20, colour=RGBColor(0xBD, 0xD7, 0xEE),
                    align=PP_ALIGN.CENTER)

# ── Helper: content slide ─────────────────────────────────────────────────────
def content_slide(title_text, bullets, source_tag=""):
    slide = prs.slides.add_slide(blank)
    # White background (default) – accent bar top
    add_rect(slide, 0, 0, 13.333, 0.12, NAVY)
    # Title bar
    add_rect(slide, 0, 0.12, 13.333, 0.95, LIGHT_GREY)
    add_textbox(slide, title_text, 0.25, 0.13, 12.8, 0.94,
                size=24, bold=True, colour=NAVY, align=PP_ALIGN.LEFT)
    # Thin separator line
    add_rect(slide, 0.25, 1.1, 12.8, 0.03, MID_BLUE)
    # Bullets
    add_bullets(slide, bullets, 0.35, 1.2, 12.6, 5.9, size=17)
    # Source tag bottom-right
    if source_tag:
        add_textbox(slide, source_tag, 9.0, 7.1, 4.0, 0.35,
                    size=10, italic=True,
                    colour=RGBColor(0x90, 0x90, 0x90),
                    align=PP_ALIGN.RIGHT)

# ── Helper: two-column slide ─────────────────────────────────────────────────
def two_col_slide(title_text, left_items, right_items,
                  left_head="", right_head="", source_tag=""):
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, 13.333, 0.12, NAVY)
    add_rect(slide, 0, 0.12, 13.333, 0.95, LIGHT_GREY)
    add_textbox(slide, title_text, 0.25, 0.13, 12.8, 0.94,
                size=24, bold=True, colour=NAVY)
    add_rect(slide, 0.25, 1.1, 12.8, 0.03, MID_BLUE)
    # column divider
    add_rect(slide, 6.55, 1.2, 0.03, 5.9, LIGHT_GREY)
    if left_head:
        add_textbox(slide, left_head, 0.35, 1.18, 6.0, 0.45,
                    size=14, bold=True, colour=MID_BLUE)
    if right_head:
        add_textbox(slide, right_head, 6.7, 1.18, 6.0, 0.45,
                    size=14, bold=True, colour=MID_BLUE)
    y_start = 1.65 if (left_head or right_head) else 1.2
    add_bullets(slide, left_items,  0.35, y_start, 6.1, 5.6, size=16)
    add_bullets(slide, right_items, 6.7,  y_start, 6.1, 5.6, size=16)
    if source_tag:
        add_textbox(slide, source_tag, 9.0, 7.1, 4.0, 0.35,
                    size=10, italic=True,
                    colour=RGBColor(0x90, 0x90, 0x90),
                    align=PP_ALIGN.RIGHT)

# ── Helper: table slide ───────────────────────────────────────────────────────
def table_slide(title_text, headers, rows, source_tag=""):
    from pptx.util import Inches, Pt
    slide = prs.slides.add_slide(blank)
    add_rect(slide, 0, 0, 13.333, 0.12, NAVY)
    add_rect(slide, 0, 0.12, 13.333, 0.95, LIGHT_GREY)
    add_textbox(slide, title_text, 0.25, 0.13, 12.8, 0.94,
                size=24, bold=True, colour=NAVY)
    add_rect(slide, 0.25, 1.1, 12.8, 0.03, MID_BLUE)

    cols = len(headers)
    col_w = [Inches(12.8 / cols)] * cols
    table = slide.shapes.add_table(
        len(rows) + 1, cols,
        Inches(0.27), Inches(1.25),
        Inches(12.8), Inches(5.8)
    ).table

    # Header row
    for ci, h in enumerate(headers):
        cell = table.cell(0, ci)
        cell.fill.solid(); cell.fill.fore_color.rgb = NAVY
        p = cell.text_frame.paragraphs[0]
        p.alignment = PP_ALIGN.CENTER
        r = p.add_run(); r.text = h
        r.font.name = "Calibri"; r.font.size = Pt(14)
        r.font.bold = True; r.font.color.rgb = WHITE

    # Data rows
    for ri, row in enumerate(rows):
        bg = WHITE if ri % 2 == 0 else LIGHT_GREY
        for ci, val in enumerate(row):
            cell = table.cell(ri + 1, ci)
            cell.fill.solid(); cell.fill.fore_color.rgb = bg
            p = cell.text_frame.paragraphs[0]
            r = p.add_run(); r.text = str(val)
            r.font.name = "Calibri"; r.font.size = Pt(13)
            r.font.color.rgb = DARK_GREY

    if source_tag:
        add_textbox(slide, source_tag, 9.0, 7.1, 4.0, 0.35,
                    size=10, italic=True,
                    colour=RGBColor(0x90, 0x90, 0x90),
                    align=PP_ALIGN.RIGHT)

# =============================================================================
# SLIDE CONTENT
# =============================================================================

B = "Bradley & Daroff's Neurology in Clinical Practice"
A = "Adams & Victor's Principles of Neurology, 12e"
BA = "Bradley & Daroff / Adams & Victor"

# ── SLIDE 1: Title ────────────────────────────────────────────────────────────
slide1 = prs.slides.add_slide(blank)
add_rect(slide1, 0, 0, 13.333, 7.5, WHITE)
add_rect(slide1, 0, 0, 13.333, 0.15, NAVY)
add_rect(slide1, 0, 7.35, 13.333, 0.15, NAVY)
# Decorative left bar
add_rect(slide1, 0, 0.15, 0.5, 7.2, NAVY)
add_rect(slide1, 0.5, 0.15, 0.08, 7.2, MID_BLUE)
add_textbox(slide1, "MIGRAINE", 1.0, 1.5, 11.8, 1.8,
            size=60, bold=True, colour=NAVY, align=PP_ALIGN.LEFT)
add_textbox(slide1,
            "A Comprehensive Review",
            1.0, 3.4, 11.8, 0.7, size=26, colour=MID_BLUE, align=PP_ALIGN.LEFT)
add_textbox(slide1,
            "Based on Bradley & Daroff's Neurology in Clinical Practice\n"
            "and Adams & Victor's Principles of Neurology, 12th Edition",
            1.0, 4.3, 11.8, 1.0, size=16, italic=True,
            colour=DARK_GREY, align=PP_ALIGN.LEFT)

# ── SLIDE 2: Table of Contents ────────────────────────────────────────────────
content_slide(
    "Table of Contents",
    [
        "1.  Definition & Historical Perspective",
        "2.  Epidemiology",
        "3.  Classification (ICHD-3)",
        "4.  Phases of Migraine Attack",
        "5.  Migraine with Aura – Clinical Features",
        "6.  Migraine without Aura – Clinical Features",
        "7.  Pathophysiology – Overview",
        "8.  Cortical Spreading Depression",
        "9.  Trigeminovascular System",
        "10. Genetics of Migraine",
        "11. Migraine Variants",
        "12. Chronic Migraine",
        "13. Diagnosis & Differential Diagnosis",
        "14. Acute / Abortive Treatment",
        "15. Preventive Treatment",
        "16. Special Populations & Comorbidities",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 1", "Definition, Epidemiology & Classification")

# ── SLIDE 3: Definition ───────────────────────────────────────────────────────
content_slide(
    "Definition of Migraine",
    [
        'The word "migraine" derives from ancient Greek hemikranios – "half head"',
        "Unilateral head pain is present in ~60–75% of patients (Kelman, 2005)",
        "Adams & Victor: a prevalent, largely familial disorder of periodic, commonly unilateral, usually pulsatile headaches",
        "Often begins in childhood, adolescence, or early adult life; recurs with diminishing frequency with age",
        "Attack consists of up to four phases: premonitory, aura, headache, postdrome",
        "Core features: throbbing headache, nausea/vomiting, photophobia, phonophobia",
        "WHO has declared migraine among the most disabling medical conditions worldwide",
    ],
    BA
)

# ── SLIDE 4: Epidemiology 1 ───────────────────────────────────────────────────
content_slide(
    "Epidemiology – Prevalence & Burden",
    [
        "1-year prevalence ~12% overall (18% women, 6% men) – Lipton et al., 2007",
        "Global Burden of Disease Study: ~15% 1-year prevalence worldwide (Stovner, 2018)",
        "Estimated 27.9 million migraine patients in the United States alone",
        ">90% report impaired function during attacks; 53% require bed rest",
        "31% missed ≥1 day from work/school in preceding 3 months",
        "Indirect economic costs: ~$13 billion/year in the US; equivalent of 112 million bedridden days/year",
        "Lifetime prevalence: ~33% in women, ~13% in men (Launer et al., 1999)",
    ],
    B
)

# ── SLIDE 5: Epidemiology 2 ───────────────────────────────────────────────────
two_col_slide(
    "Epidemiology – Demographics",
    [
        "Peak prevalence in 4th decade of life",
        "~24% of women and ~7% of men affected at peak",
        "Prepubescent boys and girls equally affected",
        "At puberty: sharp increase, especially in girls",
        "Onset before age 30 in >80% of patients",
        "Migraines typically milder and less frequent in later life",
    ],
    [
        "US ethnic differences (women / men):",
        "  White: ~20% / ~9%",
        "  African origin: ~16% / ~7%",
        "  Asian origin: ~9% / ~4%",
        "First-degree relatives of MwoA patients: 2× risk of MwoA",
        "First-degree relatives of MwA patients: 4× risk of MwA (Russell & Olesen, 1995)",
        "Strong familial aggregation – genetic predisposition established",
    ],
    "Demographics", "Genetic Risk",
    BA
)

# ── SLIDE 6: Classification ───────────────────────────────────────────────────
content_slide(
    "ICHD-3 Classification of Migraine (IHS, 2018)",
    [
        "1.1  Migraine without aura (common migraine) – most prevalent form",
        "1.2  Migraine with aura (classic migraine)",
        "       1.2.1 Migraine with typical aura",
        "       1.2.2 Migraine with brainstem aura (basilar migraine)",
        "       1.2.3 Hemiplegic migraine (familial / sporadic)",
        "       1.2.4 Retinal migraine",
        "1.3  Chronic migraine – headaches ≥15 days/month, ≥8 with migraine features",
        "1.4  Complications of migraine (status migrainosus, persistent aura, etc.)",
        "1.5  Probable migraine",
        "Ratio of classic (MwA) to common (MwoA) ≈ 1:5",
        "Same individual may experience both forms over their lifetime",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 2", "Clinical Features – Phases & Subtypes")

# ── SLIDE 7: Premonitory Phase ────────────────────────────────────────────────
content_slide(
    "Phase 1 – Premonitory (Prodrome)",
    [
        "Occurs hours to days before the headache",
        "Present in ~60–80% of migraineurs (varies by study)",
        "Symptoms reflect hypothalamic and limbic dysfunction:",
        "  – Mood changes: depression, irritability, euphoria",
        "  – Cognitive: difficulty concentrating, yawning",
        "  – Autonomic: food cravings (especially chocolate/sweet foods), thirst, polyuria",
        "  – Neck stiffness or discomfort",
        "  – Fatigue, hypersensitivity to light and sound",
        "Recognition allows early administration of abortive therapy",
        "Dopaminergic activation of hypothalamus thought to be responsible",
    ],
    B
)

# ── SLIDE 8: Aura Phase ───────────────────────────────────────────────────────
content_slide(
    "Phase 2 – Aura",
    [
        "Present in ~25–30% of migraineurs (MwA)",
        "Develops gradually over ≥5 minutes; each symptom lasts 5–60 minutes",
        "Visual aura (most common, ~90% of auras):",
        "  – Scintillating scotoma: shimmering arc of zig-zag light (fortification spectrum)",
        "  – Homonymous visual disturbance, expanding across visual field",
        "Sensory aura: unilateral paresthesiae spreading from hand → face",
        "Motor aura: rare – weakness (hemiplegic migraine)",
        "Speech aura: dysphasia / aphasia – less common",
        "Aura typically precedes headache by 20–60 minutes; may occur without headache",
        "Cortical spreading depression (CSD) is the underlying mechanism",
    ],
    BA
)

# ── SLIDE 9: Headache Phase ───────────────────────────────────────────────────
content_slide(
    "Phase 3 – Headache",
    [
        "Duration: 4–72 hours (untreated or unsuccessfully treated)",
        "Unilateral in 60–75%; bilateral or holocranial in remainder",
        "Quality: throbbing / pulsatile in majority",
        "Severity: moderate to severe; worsened by routine physical activity",
        "Associated symptoms (ICHD-3 criteria):",
        "  – Nausea and/or vomiting (most patients)",
        "  – Photophobia (light sensitivity)",
        "  – Phonophobia (sound sensitivity)",
        "  – Osmophobia: highly specific for migraine when present (Chalmer et al., 2018)",
        "  – Cutaneous allodynia: hypersensitivity of scalp/skin – sign of central sensitisation",
        "Patient prefers to lie in a dark, quiet room and tries to sleep",
    ],
    BA
)

# ── SLIDE 10: Postdrome ───────────────────────────────────────────────────────
content_slide(
    "Phase 4 – Postdrome",
    [
        'Often called the "migraine hangover"',
        "Occurs after resolution of headache in majority of patients",
        "Duration: hours to ~24 hours",
        "Symptoms include:",
        "  – Fatigue, exhaustion",
        "  – Cognitive fog ('brain fog') – difficulty concentrating",
        "  – Mood changes: depression or, paradoxically, euphoria",
        "  – Residual head tenderness / soreness at prior pain site",
        "  – Continued photosensitivity and sensitivity to movement",
        "Reflects gradual return of cortical excitability to baseline",
        "Often underappreciated and underreported – contributes substantially to disability",
    ],
    B
)

# ── SLIDE 11: MwoA Diagnostic Criteria ───────────────────────────────────────
content_slide(
    "Migraine without Aura – ICHD-3 Diagnostic Criteria",
    [
        "A. ≥5 attacks fulfilling criteria B–D",
        "B. Headache attacks lasting 4–72 hours (untreated/unsuccessfully treated)",
        "C. At least 2 of the following characteristics:",
        "   1. Unilateral location",
        "   2. Pulsating quality",
        "   3. Moderate or severe pain intensity",
        "   4. Aggravation by or causing avoidance of routine physical activity",
        "D. During headache ≥1 of the following:",
        "   1. Nausea and/or vomiting",
        "   2. Photophobia AND phonophobia",
        "E. Not better accounted for by another ICHD-3 diagnosis",
    ],
    B
)

# ── SLIDE 12: MwA Diagnostic Criteria ────────────────────────────────────────
content_slide(
    "Migraine with Aura – ICHD-3 Diagnostic Criteria",
    [
        "A. ≥2 attacks fulfilling criteria B and C",
        "B. ≥1 of the following fully reversible aura symptoms:",
        "   1. Visual",
        "   2. Sensory",
        "   3. Speech and/or language",
        "   4. Motor",
        "   5. Brainstem",
        "   6. Retinal",
        "C. ≥3 of the following 6 characteristics:",
        "   – ≥1 aura symptom spreading gradually over ≥5 min",
        "   – ≥2 aura symptoms occurring in succession",
        "   – Each aura symptom lasts 5–60 min",
        "   – ≥1 aura symptom is unilateral",
        "   – ≥1 aura symptom is positive",
        "   – Aura accompanied/followed by headache within 60 min",
    ],
    B
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 3", "Pathophysiology")

# ── SLIDE 13: Pathophysiology Overview ───────────────────────────────────────
content_slide(
    "Pathophysiology – Overview",
    [
        "Migraine is a neurovascular disorder – abnormal brain excitability + vascular changes",
        "Three key mechanisms interact:",
        "  1. Cortical Spreading Depression (CSD) – generates aura",
        "  2. Trigeminovascular activation – generates headache pain",
        "  3. Central sensitisation – mediates allodynia and chronification",
        "Hypothalamic dysfunction: orchestrates premonitory phase",
        "Brainstem (PAG, locus coeruleus, raphe nuclei) modulates pain processing",
        "Serotonin (5-HT) plays a pivotal role in migraine pathogenesis",
        "CGRP (calcitonin gene-related peptide) is a key neuropeptide in headache generation",
        "Inflammatory neuropeptides released around meningeal vessels",
    ],
    BA
)

# ── SLIDE 14: Cortical Spreading Depression ───────────────────────────────────
content_slide(
    "Cortical Spreading Depression (CSD)",
    [
        "First described by Leão (1944) in experimental animals",
        "CSD is a slowly propagating wave (~3 mm/min) of neuronal and glial depolarisation",
        "Spreads across the cortex, preceded by a brief excitatory phase, followed by sustained suppression",
        "In occipital cortex: corresponds to the visual aura (scintillating scotoma travels across visual field)",
        "CSD triggers trigeminal activation via meningeal afferents – linking aura to headache",
        "Functional MRI shows 'blood flow changes' concordant with CSD propagation during spontaneous aura",
        "Propagation follows cortical topology – explains the spreading nature of sensory aura",
        "Animal models: CSD activates trigeminocervical complex neurons",
        "CSD may sensitise peripheral and central trigeminal neurons",
    ],
    BA
)

# ── SLIDE 15: Trigeminovascular System ────────────────────────────────────────
content_slide(
    "Trigeminovascular System",
    [
        "Meningeal blood vessels are innervated by trigeminal C-fibre afferents (1st division, V1)",
        "CSD and other triggers activate trigeminal ganglia → release of CGRP, substance P, neurokinin A",
        "Neurogenic inflammation: vasodilation, plasma protein extravasation, mast cell degranulation",
        "Pain signals ascend via trigeminal nucleus caudalis (TNC) → thalamus → cortex",
        "TNC in medulla serves as the 'trigeminocervical complex' (extends to C1–C2)",
        "Central sensitisation in TNC explains: photophobia, phonophobia, cutaneous allodynia",
        "CGRP concentrations elevated in jugular venous blood during migraine attacks",
        "Anti-CGRP therapies (gepants, monoclonal antibodies) are highly effective – validates this pathway",
        "5-HT1B/1D receptor agonists (triptans) inhibit CGRP release and cause meningeal vasoconstriction",
    ],
    BA
)

# ── SLIDE 16: CSD & Neurovascular Coupling ────────────────────────────────────
content_slide(
    "Neuroinflammation & Central Sensitisation",
    [
        "Peripheral sensitisation: sustained activation of meningeal nociceptors → allodynia of pericranial area",
        "Central sensitisation: sensitisation of TNC neurons → whole-body allodynia",
        "Allodynia present in ~70% of migraineurs; predicts poor triptan response if treatment delayed",
        "Triptans most effective when given before central sensitisation is established (within 20 min of onset)",
        "Meningeal neurogenic inflammation driven by:",
        "  – CGRP (potent vasodilator)",
        "  – Substance P",
        "  – Nitric oxide (NO) – important trigger in nitroglycerin-provoked migraine",
        "  – Prostaglandins (explains NSAID efficacy)",
        "Descending modulation from PAG and nucleus raphe magnus modulates pain gate",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 4", "Genetics of Migraine")

# ── SLIDE 17: Genetics ────────────────────────────────────────────────────────
content_slide(
    "Genetics of Migraine",
    [
        "Strong heritable component – twin and sibling studies",
        "No simple Mendelian inheritance for common forms (MwoA / MwA)",
        "GWAS: ~40 susceptibility loci identified; many near genes of vascular smooth muscle (Gormley et al.)",
        "Familial Hemiplegic Migraine (FHM) – rare monogenic subtype:",
        "  FHM1: CACNA1A – Cav2.1 (P/Q-type) voltage-gated calcium channel",
        "  FHM2: ATP1A2 – Na+/K+-ATPase α2 subunit",
        "  FHM3: SCN1A – voltage-gated sodium channel Nav1.1",
        "  FHM4: PRRT2 – proline-rich transmembrane protein",
        "All FHM genes code for ion transport proteins – highlighting channelopathy basis",
        "CADASIL (NOTCH3 mutation) can present with migraine with aura",
        "MELAS syndrome: mitochondrial DNA mutation – may cause migraine-like episodes",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 5", "Migraine Variants & Special Subtypes")

# ── SLIDE 18: Hemiplegic Migraine ────────────────────────────────────────────
content_slide(
    "Hemiplegic Migraine",
    [
        "Rare subtype characterised by reversible motor weakness (hemiplegia) as part of aura",
        "Familial (FHM) or sporadic forms",
        "FHM1 (CACNA1A) – most common; also associated with cerebellar ataxia in some families",
        "FHM2 (ATP1A2) – Na+/K+ ATPase mutation",
        "FHM3 (SCN1A) – Nav1.1 sodium channel mutation",
        "Motor aura may last hours to days – much longer than typical aura",
        "Associated aura features: visual, sensory, aphasia, confusion, reduced consciousness",
        "Fever and marked meningeal irritation may occur in severe attacks",
        "Avoid triptans and ergotamines (risk of prolonged vasoconstriction); use verapamil or acetazolamide for prevention",
        "Must be differentiated from stroke, Todd's palsy, demyelinating disease",
    ],
    A
)

# ── SLIDE 19: Migraine with Brainstem Aura ────────────────────────────────────
content_slide(
    "Migraine with Brainstem Aura (Basilar Migraine)",
    [
        "Aura symptoms of brainstem origin – previously called 'basilar artery migraine' (Bickerstaff, 1961)",
        "Renamed in ICHD-3 because basilar artery involvement not proven",
        "ICHD-3: ≥2 of the following brainstem aura features:",
        "  – Dysarthria",
        "  – Vertigo",
        "  – Tinnitus",
        "  – Hypacusis (hearing loss)",
        "  – Diplopia",
        "  – Ataxia (non-hemiplegic)",
        "  – Decreased level of consciousness",
        "Followed by headache typical of migraine",
        "Common in adolescent girls; often resolves with age",
        "Syncope and drop attacks can occur – termed 'syncopal migraine'",
    ],
    BA
)

# ── SLIDE 20: Retinal & Ophthalmoplegic Migraine ──────────────────────────────
two_col_slide(
    "Retinal Migraine & Ophthalmoplegic Migraine",
    [
        "Retinal Migraine:",
        "Repeated attacks of monocular visual disturbance – scotoma, blindness",
        "Fully reversible; associated with headache",
        "Due to ischaemia or CSD in retina",
        "Rare; differential includes amaurosis fugax (TIA)",
        "Fundoscopy: retinal artery pallor during attack",
        "Triptans used cautiously – monitor for permanent visual loss",
    ],
    [
        "Ophthalmoplegic Migraine:",
        "Recurrent attacks of ophthalmoplegia (CN III most often)",
        "Headache precedes eye muscle palsy",
        "Pain in/around orbit",
        "Now classified in ICHD-3 as 'recurrent painful ophthalmoplegic neuropathy'",
        "MRI: gadolinium enhancement of oculomotor nerve during attack",
        "Corticosteroids may abort attacks; rule out aneurysm",
    ],
    "Retinal", "Ophthalmoplegic",
    A
)

# ── SLIDE 21: Chronic Migraine ────────────────────────────────────────────────
content_slide(
    "Chronic Migraine",
    [
        "Definition (ICHD-3): ≥15 headache days/month for >3 months, of which ≥8 days meet migraine criteria",
        "Prevalence: ~2% of general population; major public health burden",
        "Risk factors for chronification:",
        "  – High attack frequency (episodic migraine ≥1×/week)",
        "  – Medication overuse headache (MOH) – most important modifiable risk",
        "  – Obesity, sleep disorders, psychiatric comorbidities (anxiety, depression)",
        "  – Caffeine overuse, stressful life events",
        "Pathophysiology: central sensitisation and neuroplastic changes in pain modulation",
        "Treatment: combination of preventive pharmacotherapy + behavioural interventions + MOH management",
        "OnabotulinumtoxinA (Botox): FDA-approved for chronic migraine prevention (PREEMPT trials)",
        "CGRP mAbs (erenumab, fremanezumab, galcanezumab) effective in chronic migraine",
    ],
    B
)

# ── SLIDE 22: Menstrual & Vestibular Migraine ─────────────────────────────────
two_col_slide(
    "Menstrual Migraine & Vestibular Migraine",
    [
        "Menstrual / Catamenial Migraine:",
        "Attacks exclusively or predominantly peri-menstrual",
        "~15% of migraineurs – purely menstrual",
        "Mechanism: oestradiol withdrawal → CSD threshold reduction",
        "Typically MwoA; often severe and prolonged",
        "Management: frovatriptan mini-prophylaxis or transdermal oestrogen",
        "Pregnancy often improves migraine; may worsen in 1st trimester",
    ],
    [
        "Vestibular Migraine (VM):",
        "Most common cause of episodic vertigo in adults",
        "Vestibular symptoms lasting 5 min – 72 hours",
        "At least 50% of attacks associated with headache",
        "Photophobia / phonophobia during vertiginous episodes",
        "Differentiate from BPPV, Menière disease",
        "Treatment: same as migraine prevention; vestibular rehabilitation adjunct",
        "Betahistine not well-supported; verapamil often used",
    ],
    "Menstrual", "Vestibular",
    B
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 6", "Triggers, Diagnosis & Differential Diagnosis")

# ── SLIDE 23: Triggers ────────────────────────────────────────────────────────
two_col_slide(
    "Migraine Triggers",
    [
        "Hormonal:",
        "  – Oestrogen withdrawal (menstruation)",
        "  – Oral contraceptive pill",
        "  – Hormone replacement therapy",
        "Dietary:",
        "  – Alcohol (especially red wine, beer)",
        "  – Caffeine (excess or withdrawal)",
        "  – Tyramine-containing foods (aged cheese)",
        "  – Skipped meals, fasting",
    ],
    [
        "Environmental / Lifestyle:",
        "  – Bright light, glare, flickering lights",
        "  – Strong odours, perfumes",
        "  – Sleep disturbance (too much or too little)",
        "  – Stress and stress let-down",
        "  – Weather / barometric pressure changes",
        "Pharmacological:",
        "  – Nitroglycerin (NO donor) – classic experimental trigger",
        "  – Histamine, CGRP infusion",
        "  – Medication overuse",
    ],
    "Hormonal & Dietary", "Environmental & Other",
    B
)

# ── SLIDE 24: Diagnosis ───────────────────────────────────────────────────────
content_slide(
    "Diagnosis of Migraine",
    [
        "Migraine is a clinical diagnosis based on history – no diagnostic test confirms migraine",
        "Take a thorough headache history: onset, duration, frequency, character, severity, associated features",
        "Ask specifically about aura, triggers, family history, medication use",
        "Neurological examination: usually normal between attacks",
        "Neuroimaging is NOT routinely required for typical migraine",
        "Imaging indications (red flags –'SNOOP10'):",
        "  – Systemic symptoms / secondary risk factors",
        "  – New onset after age 50",
        "  – Onset <5 min (thunderclap), or change in established pattern",
        "  – Progressive worsening, papilloedema, focal neurological signs",
        "Headache diary: crucial for diagnosis and monitoring treatment response",
        "Validated screening tools: ID-Migraine (3-item questionnaire: nausea, disability, photophobia)",
    ],
    B
)

# ── SLIDE 25: Differential Diagnosis ─────────────────────────────────────────
two_col_slide(
    "Differential Diagnosis",
    [
        "Secondary headaches to exclude:",
        "  – Subarachnoid haemorrhage (thunderclap)",
        "  – Cerebral venous sinus thrombosis",
        "  – Arterial dissection (cervical, intracranial)",
        "  – Idiopathic intracranial hypertension",
        "  – Meningitis / encephalitis",
        "  – Space-occupying lesion",
        "  – Giant cell arteritis (>50 years)",
        "  – Carbon monoxide poisoning",
    ],
    [
        "Primary headaches to differentiate:",
        "  – Tension-type headache (bilateral, non-pulsating, no nausea)",
        "  – Cluster headache (unilateral, periorbital, short duration, autonomic)",
        "  – SUNCT / SUNA",
        "  – Hemicrania continua",
        "  – New daily persistent headache (NDPH)",
        "Visual aura must be distinguished from:",
        "  – TIA / occipital lobe ischaemia",
        "  – Retinal detachment",
        "  – Posterior cortical atrophy",
    ],
    "Secondary Headaches", "Primary Headaches",
    B
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 7", "Acute / Abortive Treatment")

# ── SLIDE 26: Acute Treatment Principles ─────────────────────────────────────
content_slide(
    "Acute Treatment – General Principles",
    [
        "Goal: rapid, complete pain relief and restoration of function within 2 hours",
        "Stratified care preferred over 'step care' approach for moderate-severe migraine",
        "Treat early in the attack – before central sensitisation is established",
        "Avoid overuse of acute medications: ≥2–3 days/week → risk of MOH (medication overuse headache)",
        "Non-pharmacological: dark quiet room, sleep, cold/warm compress, hydration",
        "Consider rescue medication for severe or refractory attacks",
        "Antiemetics often needed for nausea/vomiting (also aid absorption of oral medications)",
        "Parenteral routes (IV, SC, nasal spray) for severe attacks with vomiting",
    ],
    BA
)

# ── SLIDE 27: Simple Analgesics & NSAIDs ──────────────────────────────────────
content_slide(
    "Acute Treatment – Analgesics, NSAIDs & Antiemetics",
    [
        "Simple analgesics (mild-moderate attacks):",
        "  – Aspirin 900–1000 mg: effective in RCTs; comparable to sumatriptan in some studies",
        "  – Paracetamol (acetaminophen) 1000 mg: modest efficacy; safe in pregnancy",
        "NSAIDs (first-line for moderate attacks):",
        "  – Ibuprofen 400–600 mg",
        "  – Naproxen sodium 550–825 mg",
        "  – Diclofenac potassium 50 mg (fast-acting formulation)",
        "  – Ketorolac IM: useful in ED setting",
        "Antiemetics (adjunct – also accelerate gastric emptying for better drug absorption):",
        "  – Metoclopramide 10–20 mg (also has intrinsic anti-migraine properties)",
        "  – Prochlorperazine 10 mg PO / 25 mg PR",
        "  – Domperidone 20 mg",
        "Combination: aspirin + paracetamol + caffeine (Excedrin) – superior to components alone",
    ],
    BA
)

# ── SLIDE 28: Triptans ────────────────────────────────────────────────────────
content_slide(
    "Acute Treatment – Triptans (5-HT1B/1D Agonists)",
    [
        "Mechanism: vasoconstriction of meningeal vessels + inhibition of trigeminal CGRP release",
        "Mainstay of treatment for moderate-severe migraine; most effective if taken early",
        "7 oral triptans available (see table on next slide)",
        "Sumatriptan: most studied – 50 mg oral (first-line), 6 mg SC (fastest onset, most effective)",
        "Sumatriptan 20 mg nasal spray: useful when vomiting prevents oral intake",
        "Non-oral options: sumatriptan SC, zolmitriptan nasal spray, dihydroergotamine (DHE) nasal/IM",
        "Response in ~70–75% of patients if used within 1–2 hours of onset",
        "Contraindications: coronary artery disease, uncontrolled hypertension, history of stroke, pregnancy",
        "Serotonin agonists avoided during prolonged aura (hemiparesis, aphasia, basilar features)",
        "Not effective during aura phase – give at headache onset",
    ],
    BA
)

# ── SLIDE 29: Triptan Table ───────────────────────────────────────────────────
table_slide(
    "Oral Triptans – Dosing Reference",
    ["Triptan", "Tablet Sizes (mg)", "Optimum Dose (mg)", "Max Single Dose (mg)", "Max Daily Dose (mg)"],
    [
        ["Sumatriptan*", "25, 50, 100", "50", "100", "200"],
        ["Rizatriptan",  "5, 10",       "10", "10",  "30"],
        ["Zolmitriptan", "2.5, 5",      "2.5","5",   "10"],
        ["Eletriptan",   "20, 40",      "20", "40",  "80"],
        ["Almotriptan",  "6.25, 12.5",  "12.5","12.5","25"],
        ["Naratriptan",  "1, 2.5",      "2.5","2.5", "5"],
        ["Frovatriptan", "2.5",         "2.5","2.5", "7.5"],
    ],
    A
)

# ── SLIDE 30: Ergotamines & Gepants ───────────────────────────────────────────
content_slide(
    "Acute Treatment – Ergotamines, Gepants & Lasmiditan",
    [
        "Ergotamine tartrate:",
        "  – 1–2 mg sublingual or oral (with caffeine); rectal suppository for vomiting",
        "  – Alpha-adrenergic + serotonergic vasoconstriction",
        "  – Effective in 70–75% if given early; risk of ergotism with overuse → daily headache",
        "Dihydroergotamine (DHE):",
        "  – 0.5–1 mg IV/IM/SC; nasal spray; superior to ergotamine for efficacy/tolerability",
        "  – IV DHE + antiemetic: effective rescue for intractable headache in ED",
        "Gepants (CGRP receptor antagonists) – oral, no vasoconstriction:",
        "  – Ubrogepant, Rimegepant – approved for acute treatment",
        "  – Safe in patients with cardiovascular risk where triptans are contraindicated",
        "Lasmiditan (5-HT1F agonist, 'ditan'):",
        "  – No vasoconstriction; CNS-specific mechanism",
        "  – Effective for acute migraine; dizziness main side effect; Schedule V (CNS effects)",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 8", "Preventive Treatment")

# ── SLIDE 31: Indications for Prevention ──────────────────────────────────────
content_slide(
    "Preventive Treatment – Indications",
    [
        "Preventive therapy indicated when:",
        "  – ≥4 migraine days/month causing significant disability",
        "  – Acute medication overuse or acute treatments ineffective/contraindicated",
        "  – Severe or prolonged attacks (including hemiplegic or basilar migraine)",
        "  – Patient preference even with less frequent attacks",
        "Goal: reduce attack frequency ≥50%, severity, duration, and disability",
        "Adequate trial: at least 2–3 months at therapeutic dose",
        "Lifestyle measures always accompany pharmacological prevention:",
        "  – Regular sleep, exercise, meals; stress management",
        "  – Avoidance of known triggers",
        "  – Headache diary to monitor progress",
        "Patient education is essential – treatment adherence is critical",
    ],
    B
)

# ── SLIDE 32: Preventive Drugs ────────────────────────────────────────────────
two_col_slide(
    "Preventive Treatment – Pharmacological Options",
    [
        "Beta-blockers (Level A evidence):",
        "  – Propranolol 40–240 mg/day",
        "  – Metoprolol 100–200 mg/day",
        "  – Timolol 20–30 mg/day",
        "Antidepressants:",
        "  – Amitriptyline 10–75 mg/night (most evidence among TCAs)",
        "  – Venlafaxine 75–150 mg/day (SNRI)",
        "Anticonvulsants:",
        "  – Topiramate 50–200 mg/day (Level A)",
        "  – Valproate / sodium valproate 500–1000 mg/day",
        "  – Gabapentin: modest evidence",
    ],
    [
        "Calcium channel blockers:",
        "  – Flunarizine 5–10 mg/night (most evidence in Europe)",
        "  – Verapamil (mainly for cluster; also used in hemiplegic migraine)",
        "CGRP pathway monoclonal antibodies (mAbs):",
        "  – Erenumab (anti-CGRP receptor) – monthly SC",
        "  – Fremanezumab (anti-CGRP ligand) – monthly or quarterly SC",
        "  – Galcanezumab (anti-CGRP ligand) – monthly SC",
        "  – Eptinezumab (anti-CGRP ligand) – quarterly IV",
        "OnabotulinumtoxinA (Botox):",
        "  – 31 injection sites, 155 U every 12 weeks – for chronic migraine only",
        "  – PREEMPT protocol; FDA-approved",
    ],
    "Oral Preventives", "Newer Therapies",
    B
)

# ── SLIDE 33: CGRP Therapies ──────────────────────────────────────────────────
content_slide(
    "CGRP-Targeted Therapies – A New Era",
    [
        "CGRP and its receptor are expressed in trigeminal ganglia and meningeal vessels",
        "CGRP levels rise during migraine attacks; fall after successful triptan treatment",
        "CGRP infusion reliably induces migraine in susceptible individuals",
        "Gepants (small molecule CGRP-RA): ubrogepant, rimegepant, atogepant (daily oral preventive)",
        "Monoclonal antibodies: monthly or quarterly dosing – high specificity and tolerability",
        "Erenumab (Aimovig): targets CGRP receptor; 50 or 140 mg SC monthly",
        "Fremanezumab (Ajovy): 225 mg monthly or 675 mg quarterly SC",
        "Galcanezumab (Emgality): 240 mg loading → 120 mg monthly SC",
        "Eptinezumab (Vyepti): 100 or 300 mg IV every 3 months",
        "Clinical trials show 50% responder rates ~50–60% for episodic migraine",
        "Key advantage: no hepatotoxicity or cognitive side-effects of older preventives",
    ],
    BA
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 9", "Special Populations, Comorbidities & Status Migrainosus")

# ── SLIDE 34: Migraine in Special Populations ─────────────────────────────────
two_col_slide(
    "Migraine in Special Populations",
    [
        "Paediatric Migraine:",
        "  – Often bilateral, frontal-temporal",
        "  – Duration may be shorter (2–72 h)",
        "  – Abdominal migraine & cyclical vomiting are childhood equivalents",
        "  – Ibuprofen, paracetamol first-line; almotriptan / rizatriptan approved ≥12 yrs",
        "  – Propranolol, topiramate, amitriptyline for prevention",
        "",
        "Migraine in Elderly:",
        "  – Be cautious: new-onset headache after 50 → investigate",
        "  – 'Late-life migrainous accompaniments' (Fisher) – visual aura without headache",
    ],
    [
        "Pregnancy:",
        "  – Often improves after 1st trimester (oestrogen stabilisation)",
        "  – Paracetamol: safest acute treatment",
        "  – Aspirin (low dose, 2nd trimester caution), metoclopramide safe",
        "  – Triptans: generally avoided (limited safety data); sumatriptan registry reassuring",
        "  – Avoid valproate, ergotamines, NSAIDs in 3rd trimester",
        "  – Magnesium IV: option for severe acute treatment and prevention",
        "",
        "Contraception & OCP:",
        "  – Combined OCP: contraindicated in MwA (↑ stroke risk)",
        "  – Progestogen-only or non-hormonal methods preferred",
    ],
    "Paediatric & Elderly", "Pregnancy & Contraception",
    B
)

# ── SLIDE 35: Comorbidities ───────────────────────────────────────────────────
content_slide(
    "Comorbidities of Migraine",
    [
        "Psychiatric comorbidities (bidirectional association):",
        "  – Depression: 3× more prevalent in migraineurs; treat to improve both",
        "  – Anxiety disorders: generalised anxiety, panic disorder",
        "  – PTSD, bipolar disorder",
        "Cardiovascular / Cerebrovascular:",
        "  – MwA: ~2× risk of ischaemic stroke; higher in young women on combined OCP who smoke",
        "  – Patent foramen ovale (PFO): higher prevalence in MwA; PFO closure – not routinely recommended for migraine",
        "  – Increased risk of white matter hyperintensities on MRI",
        "Other:",
        "  – Epilepsy: migralepsy (migraine-triggered seizure)",
        "  – Fibromyalgia, irritable bowel syndrome – central sensitisation spectrum",
        "  – Sleep disorders: insomnia, sleep apnoea",
        "  – Raynaud phenomenon",
    ],
    B
)

# ── SLIDE 36: Status Migrainosus & Complications ──────────────────────────────
content_slide(
    "Status Migrainosus & Complications of Migraine",
    [
        "Status Migrainosus: debilitating migraine attack lasting >72 hours",
        "  – Often associated with medication overuse",
        "  – Requires parenteral treatment: IV DHE + antiemetic, IV ketorolac, IV valproate, IV dexamethasone",
        "Persistent Aura without Infarction:",
        "  – Aura lasting >1 week without evidence of infarction on neuroimaging",
        "Migrainous Infarction:",
        "  – Ischaemic infarct during migraine with aura (area corresponds to aura deficit)",
        "  – Rare – DWI MRI confirms",
        "  – Risk factor: young women + OCP + MwA + smoking",
        "Migraine Aura-Triggered Seizure (Migralepsy):",
        "  – Seizure within 1 hour of migraine aura",
        "Medication Overuse Headache (MOH):",
        "  – Triptans ≥10 days/month or NSAIDs/opioids ≥15 days/month → chronic daily headache",
        "  – Management: education + gradual or abrupt withdrawal + bridging therapy",
    ],
    B
)

# ── SECTION DIVIDER ───────────────────────────────────────────────────────────
section_slide("SECTION 10", "Management Summary & Future Directions")

# ── SLIDE 37: Comprehensive Management Algorithm ──────────────────────────────
content_slide(
    "Comprehensive Management Algorithm",
    [
        "Step 1 – Accurate Diagnosis: ICHD-3 criteria; exclude secondary causes; headache diary",
        "Step 2 – Patient Education: nature of migraine, triggers, lifestyle modifications, medication overuse risks",
        "Step 3 – Acute Treatment:",
        "   Mild-moderate: NSAIDs ± antiemetic (paracetamol, ibuprofen, aspirin)",
        "   Moderate-severe: triptan ± NSAID (stratified care)",
        "   Severe/refractory: parenteral DHE, IV ketorolac, antiemetics",
        "Step 4 – Preventive Treatment (if ≥4 migraine days/month):",
        "   First-line: propranolol, topiramate, amitriptyline",
        "   Second-line: CGRP mAbs, flunarizine, valproate",
        "   Chronic migraine: add onabotulinumtoxinA + CGRP mAb",
        "Step 5 – Multidisciplinary Care: neurology, psychology/CBT, physiotherapy, pain clinic",
        "Step 6 – Regular Follow-up: reassess frequency, disability (MIDAS/HIT-6), and medication use",
    ],
    BA
)

# ── SLIDE 38: Migraine & Stroke ───────────────────────────────────────────────
content_slide(
    "Migraine & Stroke",
    [
        "MwA carries ~2× relative risk of ischaemic stroke (meta-analyses)",
        "Absolute risk remains low in young women without other risk factors",
        "Risk is multiplicative with:",
        "  – Combined oral contraceptive pill (OCP): ≈8× risk vs non-migraine, non-OCP",
        "  – Smoking",
        "Possible mechanisms:",
        "  – Cardioembolic (PFO-mediated paradoxical embolism)",
        "  – CSD-induced cortical ischaemia during prolonged aura",
        "  – Hypercoagulable state during attacks",
        "Migrainous infarction: infarct in area corresponding to aura deficit – extremely rare",
        "MwoA: no clearly established stroke risk",
        "Management: eliminate modifiable risk factors; prefer progestogen-only contraception",
        "Avoid triptans and ergots during focal aura with neurological deficits",
    ],
    B
)

# ── SLIDE 39: New & Emerging Therapies ────────────────────────────────────────
content_slide(
    "Emerging & Future Therapies",
    [
        "Anti-CGRP pathway continues to expand:",
        "  – Atogepant (Qulipta): oral gepant approved for daily preventive use",
        "  – Zavegepant: nasal gepant for acute treatment",
        "Non-invasive neurostimulation:",
        "  – Single-pulse TMS (sTMS): approved for acute treatment of MwA",
        "  – External trigeminal neurostimulation (eTNS – Cefaly): preventive",
        "  – Remote electrical neuromodulation (REN – Nerivio): wearable acute device",
        "  – Non-invasive vagus nerve stimulation (nVNS – gammaCore): acute and preventive",
        "Invasive neurostimulation (refractory cases):",
        "  – Occipital nerve stimulation (ONS)",
        "  – Sphenopalatine ganglion stimulation",
        "Monoclonal antibodies under investigation targeting PACAP, pituitary adenylate cyclase",
        "Personalised medicine: pharmacogenomics to predict triptan/preventive response",
        "Digital therapeutics: app-based CBT + biofeedback for migraine management",
    ],
    B
)

# ── SLIDE 40: Key Take-Home Messages ──────────────────────────────────────────
slide40 = prs.slides.add_slide(blank)
add_rect(slide40, 0, 0, 13.333, 7.5, WHITE)
add_rect(slide40, 0, 0, 13.333, 0.12, NAVY)
add_rect(slide40, 0, 0.12, 13.333, 0.95, LIGHT_GREY)
add_textbox(slide40, "Key Take-Home Messages", 0.25, 0.13, 12.8, 0.94,
            size=24, bold=True, colour=NAVY)
add_rect(slide40, 0.25, 1.1, 12.8, 0.03, MID_BLUE)

messages = [
    ("1", "Migraine is a neurovascular disorder with a strong genetic basis – not just a headache"),
    ("2", "Classification (ICHD-3) distinguishes MwA, MwoA, chronic migraine, and rare variants"),
    ("3", "CSD underlies aura; trigeminovascular activation + CGRP release underlie pain"),
    ("4", "Treat early with triptans for moderate-severe migraine; avoid overuse (>2–3 days/week)"),
    ("5", "Prevent when ≥4 migraine days/month – beta-blockers, topiramate, amitriptyline, or CGRP mAbs"),
    ("6", "CGRP-targeted therapies (gepants & mAbs) represent a precision-medicine breakthrough"),
    ("7", "MwA + OCP + smoking = high stroke risk – modify aggressively"),
    ("8", "Chronic migraine and MOH are preventable with early intervention and patient education"),
]

for i, (num, msg) in enumerate(messages):
    y = 1.2 + i * 0.72
    add_rect(slide40, 0.3, y, 0.5, 0.5, NAVY)
    add_textbox(slide40, num, 0.3, y, 0.5, 0.5,
                size=18, bold=True, colour=WHITE, align=PP_ALIGN.CENTER)
    add_textbox(slide40, msg, 1.0, y + 0.02, 11.9, 0.55,
                size=16, colour=DARK_GREY)

add_textbox(slide40,
            "Sources: Bradley & Daroff's Neurology in Clinical Practice | Adams & Victor's Principles of Neurology, 12e",
            0.25, 7.1, 12.8, 0.35,
            size=10, italic=True,
            colour=RGBColor(0x90, 0x90, 0x90),
            align=PP_ALIGN.CENTER)

# ── SAVE ──────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/migraine-ppt/Migraine_Bradley_Adams_Neurology.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")
print(f"Total slides: {len(prs.slides)}")