histamine headache antihistamine relief

headache relieved by levocetirizine antihistamine histamine intolerance mechanism 2024

ls -la /home/daytona/workspace/ 2>/dev/null && mkdir -p /home/daytona/workspace/…

~/headache-pptx/build.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Headache Comparison: Histamine vs Migraine vs Cluster";

// ─────────────────────────────────────────────
// PALETTE
// Deep navy bg, warm amber accent, cool teal, crimson
const BG_DARK   = "0D1B2A"; // deep navy
const BG_MID    = "1B2E45"; // mid navy
const ACCENT1   = "E8A838"; // amber (histamine)
const ACCENT2   = "7EC8C8"; // teal (migraine)
const ACCENT3   = "D9534F"; // crimson (cluster)
const WHITE     = "FFFFFF";
const LIGHT     = "E8EEF4";
const MUTED     = "8DA9C0";
const SLIDE_W   = 13.3;
const SLIDE_H   = 7.5;

// ─────────────────────────────────────────────
// HELPERS
function addDarkBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: SLIDE_W, h: SLIDE_H,
    fill: { color: BG_DARK }, line: { type: "none" }
  });
}
function addMidBg(slide) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: SLIDE_W, h: SLIDE_H,
    fill: { color: BG_MID }, line: { type: "none" }
  });
}
function accentBar(slide, color) {
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: 0.12, h: SLIDE_H,
    fill: { color }, line: { type: "none" }
  });
}
function slideLabel(slide, txt, color) {
  slide.addText(txt, {
    x: 0.25, y: SLIDE_H - 0.35, w: 5, h: 0.28,
    fontSize: 8, color: MUTED, bold: false, fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addDarkBg(s);

  // Top accent stripe
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: 0, w: SLIDE_W, h: 0.08,
    fill: { color: ACCENT1 }, line: { type: "none" }
  });
  // Bottom accent stripe
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0, y: SLIDE_H - 0.08, w: SLIDE_W, h: 0.08,
    fill: { color: ACCENT3 }, line: { type: "none" }
  });

  // Three colored dots representing the three headaches
  const dotY = 1.8;
  const dots = [
    { x: 2.8, color: ACCENT1, label: "Histamine" },
    { x: 5.8, color: ACCENT2, label: "Migraine" },
    { x: 8.8, color: ACCENT3, label: "Cluster" }
  ];
  dots.forEach(d => {
    s.addShape(pres.shapes.OVAL, {
      x: d.x, y: dotY, w: 0.55, h: 0.55,
      fill: { color: d.color }, line: { type: "none" }
    });
  });

  // Main title
  s.addText("HEADACHE TYPES", {
    x: 0.5, y: 2.7, w: SLIDE_W - 1, h: 1.1,
    fontSize: 52, bold: true, color: WHITE,
    align: "center", fontFace: "Calibri", charSpacing: 6
  });

  // Subtitle
  s.addText("Histamine  ·  Migraine  ·  Cluster", {
    x: 0.5, y: 3.85, w: SLIDE_W - 1, h: 0.55,
    fontSize: 22, bold: false, color: LIGHT,
    align: "center", fontFace: "Calibri"
  });

  // Tagline
  s.addText("A clinical comparison for diagnosis & management", {
    x: 0.5, y: 4.55, w: SLIDE_W - 1, h: 0.4,
    fontSize: 14, bold: false, color: MUTED,
    align: "center", fontFace: "Calibri", italic: true
  });
}

// ─────────────────────────────────────────────
// SLIDE 2 — OVERVIEW / AT-A-GLANCE TABLE
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addMidBg(s);
  accentBar(s, ACCENT2);

  // Section label
  s.addText("OVERVIEW", {
    x: 0.3, y: 0.18, w: 3, h: 0.3,
    fontSize: 9, color: MUTED, bold: true, charSpacing: 4, fontFace: "Calibri"
  });

  s.addText("At a Glance", {
    x: 0.3, y: 0.52, w: SLIDE_W - 0.6, h: 0.65,
    fontSize: 34, bold: true, color: WHITE, fontFace: "Calibri"
  });

  // Column header boxes
  const colX = [2.0, 5.5, 9.0];
  const colW = 3.2;
  const colColors = [ACCENT1, ACCENT2, ACCENT3];
  const colLabels = ["Histamine Headache", "Migraine", "Cluster Headache"];

  colX.forEach((x, i) => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 1.35, w: colW, h: 0.5,
      fill: { color: colColors[i] }, line: { type: "none" }, rectRadius: 0.08
    });
    s.addText(colLabels[i], {
      x, y: 1.35, w: colW, h: 0.5,
      fontSize: 14, bold: true, color: BG_DARK, align: "center",
      fontFace: "Calibri", valign: "middle", margin: 0
    });
  });

  // Row definitions
  const rows = [
    { label: "Prevalence",    vals: ["~1% (histamine intolerance)", "~15% of adults", "0.1% of adults"] },
    { label: "Sex",           vals: ["F > M", "F:M = 3:1", "M:F = 3:1"] },
    { label: "Pain type",     vals: ["Throbbing / pressure", "Throbbing, pulsating", "Severe, boring/stabbing"] },
    { label: "Duration",      vals: ["Variable, recurrent", "4–72 hours", "15–180 min/attack"] },
    { label: "Location",      vals: ["Diffuse / frontal", "Unilateral (often)", "Strictly unilateral, orbital"] },
    { label: "Key trigger",   vals: ["Dietary histamine / allergen", "Many (hormones, stress, food)", "Alcohol, nitroglycerin"] },
  ];

  const rowH = 0.52;
  const rowStartY = 1.98;

  rows.forEach((row, ri) => {
    const y = rowStartY + ri * rowH;
    const rowBg = ri % 2 === 0 ? "162035" : BG_MID;

    // Row bg
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.2, y, w: SLIDE_W - 0.4, h: rowH - 0.04,
      fill: { color: rowBg }, line: { type: "none" }
    });

    // Row label
    s.addText(row.label, {
      x: 0.25, y, w: 1.6, h: rowH - 0.04,
      fontSize: 11, bold: true, color: MUTED,
      fontFace: "Calibri", valign: "middle"
    });

    // Values
    colX.forEach((cx, ci) => {
      s.addText(row.vals[ci], {
        x: cx, y, w: colW, h: rowH - 0.04,
        fontSize: 11, color: LIGHT,
        fontFace: "Calibri", valign: "middle", align: "center"
      });
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 3 — HISTAMINE HEADACHE (deep dive)
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addDarkBg(s);
  accentBar(s, ACCENT1);

  // Header band
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.2, y: 0, w: SLIDE_W - 0.2, h: 1.1,
    fill: { color: ACCENT1 }, line: { type: "none" }
  });
  s.addText("HISTAMINE HEADACHE", {
    x: 0.35, y: 0.05, w: 10, h: 0.6,
    fontSize: 28, bold: true, color: BG_DARK, fontFace: "Calibri"
  });
  s.addText("Also known as: Dietary histamine / Histamine Intolerance headache", {
    x: 0.35, y: 0.65, w: 11, h: 0.38,
    fontSize: 13, color: BG_MID, fontFace: "Calibri", italic: true
  });

  // Cards
  const cardData = [
    {
      title: "Pathophysiology",
      color: "1A2E45",
      x: 0.25, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "H1 receptor activation on cerebral vessels",
        "Vasodilation → stretching of vessel walls",
        "Neurogenic inflammation",
        "Reduced DAO enzyme → histamine accumulates",
        "Estrogen promotes mast cell histamine release"
      ]
    },
    {
      title: "Clinical Features",
      color: "1A2E45",
      x: 4.35, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "Throbbing / pressure-type pain",
        "Diffuse or frontal location",
        "Often with flushing, rhinorrhoea",
        "Urticaria or skin flushing may co-occur",
        "Relieved by H1-antihistamines (e.g., levocetirizine)"
      ]
    },
    {
      title: "Triggers",
      color: "1A2E45",
      x: 8.45, y: 1.25, w: 4.6, h: 2.5,
      points: [
        "Fermented foods (cheese, wine, sauerkraut)",
        "Processed meats, canned fish",
        "Alcohol (especially red wine)",
        "Allergen exposure",
        "Perimenstrual hormonal fluctuation"
      ]
    }
  ];

  cardData.forEach(c => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x: c.x, y: c.y, w: c.w, h: c.h,
      fill: { color: c.color },
      line: { color: ACCENT1, pt: 1.5 },
      rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.25 }
    });
    s.addText(c.title, {
      x: c.x + 0.12, y: c.y + 0.1, w: c.w - 0.24, h: 0.38,
      fontSize: 13, bold: true, color: ACCENT1, fontFace: "Calibri"
    });
    s.addText(
      c.points.map(p => ({ text: p, options: { bullet: { indent: 12 }, breakLine: true } })),
      {
        x: c.x + 0.12, y: c.y + 0.52, w: c.w - 0.24, h: c.h - 0.65,
        fontSize: 10.5, color: LIGHT, fontFace: "Calibri", valign: "top"
      }
    );
  });

  // Treatment
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.25, y: 3.92, w: SLIDE_W - 0.5, h: 1.65,
    fill: { color: "12243A" }, line: { color: ACCENT1, pt: 1 }
  });
  s.addText("MANAGEMENT", {
    x: 0.4, y: 3.98, w: 3, h: 0.32,
    fontSize: 11, bold: true, color: ACCENT1, fontFace: "Calibri", charSpacing: 3
  });

  const txts = [
    { label: "Acute", val: "Levocetirizine 5 mg PO / Cetirizine 10 mg PO" },
    { label: "Dietary", val: "Low-histamine diet trial (4 weeks)" },
    { label: "Lab workup", val: "Serum DAO enzyme level, specific IgE panel" },
    { label: "Preventive", val: "Regular antihistamine; avoid triggers; hormonal review if perimenstrual" }
  ];

  txts.forEach((t, i) => {
    const tx = 0.4 + i * 3.2;
    s.addText(t.label + ":", {
      x: tx, y: 4.38, w: 3.1, h: 0.28,
      fontSize: 10, bold: true, color: ACCENT1, fontFace: "Calibri"
    });
    s.addText(t.val, {
      x: tx, y: 4.68, w: 3.05, h: 0.75,
      fontSize: 10, color: LIGHT, fontFace: "Calibri"
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 4 — MIGRAINE (deep dive)
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addDarkBg(s);
  accentBar(s, ACCENT2);

  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.2, y: 0, w: SLIDE_W - 0.2, h: 1.1,
    fill: { color: ACCENT2 }, line: { type: "none" }
  });
  s.addText("MIGRAINE", {
    x: 0.35, y: 0.05, w: 10, h: 0.6,
    fontSize: 28, bold: true, color: BG_DARK, fontFace: "Calibri"
  });
  s.addText("Primary headache disorder — most common disabling headache in women", {
    x: 0.35, y: 0.65, w: 11, h: 0.38,
    fontSize: 13, color: BG_MID, fontFace: "Calibri", italic: true
  });

  const cardData = [
    {
      title: "Pathophysiology",
      color: "1A2E45",
      x: 0.25, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "Cortical spreading depression (CSD)",
        "Trigeminovascular activation",
        "Release of CGRP, substance P",
        "Neurogenic dural inflammation",
        "Serotonin (5-HT1) dysregulation",
        "Histamine plays a co-triggering role"
      ]
    },
    {
      title: "Clinical Features",
      color: "1A2E45",
      x: 4.35, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "Moderate-severe unilateral throbbing pain",
        "Nausea and/or vomiting",
        "Photophobia and phonophobia",
        "Aura in ~30%: visual, sensory, speech",
        "Duration: 4–72 hours",
        "Worsened by physical activity"
      ]
    },
    {
      title: "Triggers",
      color: "1A2E45",
      x: 8.45, y: 1.25, w: 4.6, h: 2.5,
      points: [
        "Hormonal fluctuations (menstruation)",
        "Sleep disruption",
        "Stress and anxiety",
        "Dietary: caffeine, alcohol, tyramine",
        "Bright lights, strong odors",
        "Weather changes, dehydration"
      ]
    }
  ];

  cardData.forEach(c => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x: c.x, y: c.y, w: c.w, h: c.h,
      fill: { color: c.color },
      line: { color: ACCENT2, pt: 1.5 },
      rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.25 }
    });
    s.addText(c.title, {
      x: c.x + 0.12, y: c.y + 0.1, w: c.w - 0.24, h: 0.38,
      fontSize: 13, bold: true, color: ACCENT2, fontFace: "Calibri"
    });
    s.addText(
      c.points.map(p => ({ text: p, options: { bullet: { indent: 12 }, breakLine: true } })),
      {
        x: c.x + 0.12, y: c.y + 0.52, w: c.w - 0.24, h: c.h - 0.65,
        fontSize: 10.5, color: LIGHT, fontFace: "Calibri", valign: "top"
      }
    );
  });

  // Treatment
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.25, y: 3.92, w: SLIDE_W - 0.5, h: 1.65,
    fill: { color: "12243A" }, line: { color: ACCENT2, pt: 1 }
  });
  s.addText("MANAGEMENT", {
    x: 0.4, y: 3.98, w: 3, h: 0.32,
    fontSize: 11, bold: true, color: ACCENT2, fontFace: "Calibri", charSpacing: 3
  });

  const txts = [
    { label: "Acute (mild-mod)", val: "NSAIDs (ibuprofen, naproxen), paracetamol + antiemetic" },
    { label: "Acute (mod-severe)", val: "Triptans (sumatriptan, rizatriptan) — 5-HT1 agonists" },
    { label: "CGRP antagonists", val: "Gepants (rimegepant, ubrogepant) — newer acute therapy" },
    { label: "Prophylaxis", val: "Topiramate, propranolol, amitriptyline, CGRP mAbs (erenumab)" }
  ];

  txts.forEach((t, i) => {
    const tx = 0.4 + i * 3.2;
    s.addText(t.label + ":", {
      x: tx, y: 4.38, w: 3.1, h: 0.28,
      fontSize: 10, bold: true, color: ACCENT2, fontFace: "Calibri"
    });
    s.addText(t.val, {
      x: tx, y: 4.68, w: 3.05, h: 0.75,
      fontSize: 10, color: LIGHT, fontFace: "Calibri"
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 5 — CLUSTER HEADACHE (deep dive)
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addDarkBg(s);
  accentBar(s, ACCENT3);

  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.2, y: 0, w: SLIDE_W - 0.2, h: 1.1,
    fill: { color: ACCENT3 }, line: { type: "none" }
  });
  s.addText("CLUSTER HEADACHE", {
    x: 0.35, y: 0.05, w: 10, h: 0.6,
    fontSize: 28, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addText("Also known as: \"Histamine headache\" (Horton, 1939) — most painful primary headache", {
    x: 0.35, y: 0.65, w: 12, h: 0.38,
    fontSize: 13, color: "FFD0CE", fontFace: "Calibri", italic: true
  });

  const cardData = [
    {
      title: "Pathophysiology",
      color: "1A2E45",
      x: 0.25, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "Hypothalamic dysregulation (circadian clock)",
        "Trigeminal nerve activation",
        "Parasympathetic autonomic activation",
        "Histamine reproduced attacks (Horton 1939)",
        "Serotonin and CGRP involvement",
        "Nocturnal/circadian pattern"
      ]
    },
    {
      title: "Clinical Features",
      color: "1A2E45",
      x: 4.35, y: 1.25, w: 3.9, h: 2.5,
      points: [
        "Excruciating unilateral orbital/temporal pain",
        "Duration: 15–180 min, up to 8×/day",
        "Ipsilateral: lacrimation, conjunctival injection",
        "Ipsilateral: miosis, ptosis (Horner's)",
        "Nasal congestion / rhinorrhoea",
        "Restlessness — patient cannot lie still"
      ]
    },
    {
      title: "Two Forms",
      color: "1A2E45",
      x: 8.45, y: 1.25, w: 4.6, h: 2.5,
      points: [
        "EPISODIC: clusters 7d–1yr, remission ≥1 month",
        "CHRONIC: no remission or <1 month free",
        "",
        "Predominantly males (M:F = 3:1)",
        "Peak age 20–40 years",
        "Often nocturnal — awakens from sleep"
      ]
    }
  ];

  cardData.forEach(c => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x: c.x, y: c.y, w: c.w, h: c.h,
      fill: { color: c.color },
      line: { color: ACCENT3, pt: 1.5 },
      rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 8, offset: 2, angle: 135, opacity: 0.25 }
    });
    s.addText(c.title, {
      x: c.x + 0.12, y: c.y + 0.1, w: c.w - 0.24, h: 0.38,
      fontSize: 13, bold: true, color: ACCENT3, fontFace: "Calibri"
    });
    s.addText(
      c.points.filter(p => p).map(p => ({ text: p, options: { bullet: { indent: 12 }, breakLine: true } })),
      {
        x: c.x + 0.12, y: c.y + 0.52, w: c.w - 0.24, h: c.h - 0.65,
        fontSize: 10.5, color: LIGHT, fontFace: "Calibri", valign: "top"
      }
    );
  });

  // Treatment
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.25, y: 3.92, w: SLIDE_W - 0.5, h: 1.65,
    fill: { color: "12243A" }, line: { color: ACCENT3, pt: 1 }
  });
  s.addText("MANAGEMENT", {
    x: 0.4, y: 3.98, w: 3, h: 0.32,
    fontSize: 11, bold: true, color: ACCENT3, fontFace: "Calibri", charSpacing: 3
  });

  const txts = [
    { label: "Abortive #1", val: "High-flow O₂: 100% at 8–12 L/min × 15 min (non-rebreather)" },
    { label: "Abortive #2", val: "Sumatriptan 6 mg SC or intranasal; Zolmitriptan intranasal" },
    { label: "Prophylaxis", val: "Verapamil (1st choice); Topiramate, Divalproex" },
    { label: "Short-term bridge", val: "Oral prednisone taper or suboccipital steroid injection" }
  ];

  txts.forEach((t, i) => {
    const tx = 0.4 + i * 3.2;
    s.addText(t.label + ":", {
      x: tx, y: 4.38, w: 3.1, h: 0.28,
      fontSize: 10, bold: true, color: ACCENT3, fontFace: "Calibri"
    });
    s.addText(t.val, {
      x: tx, y: 4.68, w: 3.05, h: 0.75,
      fontSize: 10, color: LIGHT, fontFace: "Calibri"
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 6 — KEY DIFFERENTIATORS (comparison grid)
// ─────────────────────────────────────────────
{
  const s = pres.addSlide();
  addMidBg(s);
  accentBar(s, ACCENT1);

  s.addText("DIFFERENTIATING FEATURES", {
    x: 0.3, y: 0.15, w: 5, h: 0.3,
    fontSize: 9, bold: true, color: MUTED, charSpacing: 4, fontFace: "Calibri"
  });
  s.addText("How to Tell Them Apart", {
    x: 0.3, y: 0.48, w: SLIDE_W - 0.6, h: 0.65,
    fontSize: 34, bold: true, color: WHITE, fontFace: "Calibri"
  });

  const colX = [2.15, 5.55, 9.0];
  const colW = 3.25;
  const colColors = [ACCENT1, ACCENT2, ACCENT3];
  const colLabels = ["Histamine", "Migraine", "Cluster"];

  colX.forEach((x, i) => {
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x, y: 1.28, w: colW, h: 0.46,
      fill: { color: colColors[i] }, line: { type: "none" }, rectRadius: 0.06
    });
    s.addText(colLabels[i], {
      x, y: 1.28, w: colW, h: 0.46,
      fontSize: 14, bold: true, color: BG_DARK, align: "center",
      fontFace: "Calibri", valign: "middle", margin: 0
    });
  });

  const rows = [
    { label: "Pain quality",       vals: ["Pressure/throbbing", "Throbbing/pulsating", "Stabbing/boring"] },
    { label: "Laterality",         vals: ["Bilateral/diffuse", "Usually unilateral", "Always unilateral"] },
    { label: "Autonomic signs",    vals: ["Flushing, urticaria", "Nausea, vomiting", "Lacrimation, miosis, ptosis"] },
    { label: "Nausea/Vomiting",    vals: ["Mild (histamine effect)", "Prominent", "Absent or mild"] },
    { label: "Relief agent",       vals: ["Antihistamines ✓", "Triptans / NSAIDs ✓", "O₂ / Triptans ✓"] },
    { label: "Antihistamine?",     vals: ["Effective ✓✓", "Partial in some", "Not standard treatment"] },
    { label: "Diagnostic test",    vals: ["DAO levels; diet trial", "Clinical (ICHD-3)", "Clinical; MRI to exclude"] },
  ];

  const rowH = 0.5;
  const rowStartY = 1.84;

  rows.forEach((row, ri) => {
    const y = rowStartY + ri * rowH;
    const rowBg = ri % 2 === 0 ? "142030" : BG_MID;

    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.2, y, w: SLIDE_W - 0.4, h: rowH - 0.04,
      fill: { color: rowBg }, line: { type: "none" }
    });

    s.addText(row.label, {
      x: 0.25, y, w: 1.75, h: rowH - 0.04,
      fontSize: 11, bold: true, color: MUTED,
      fontFace: "Calibri", valign: "middle"
    });

    colX.forEach((cx, ci) => {
      s.addText(row.vals[ci], {
        x: cx, y, w: colW, h: rowH - 0.04,
        fontSize: 10.5, color: LIGHT,
        fontFace: "Calibri", valign: "middle", align: "center"
      });
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 7 — HISTAMINE ROLE ACROSS ALL THREE
// ─────────────────────────────────────────────
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    x: 0, y: 0, w: SLIDE_W, h: 1.0,
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  s.addText("The Role of Histamine", {
    x: 0.4, y: 0.08, w: 9, h: 0.55,
    fontSize: 30, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addText("How histamine connects all three headache types", {
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    fontSize: 13, color: MUTED, italic: true, fontFace: "Calibri"
  });

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    {
      title: "Histamine Headache",
      color: ACCENT1, textColor: BG_DARK,
      x: 0.25, y: 1.1, w: 4.0, h: 5.9,
      content: [
        "PRIMARY driver of headache",
        "",
        "• H1 receptor activation on cerebral and meningeal blood vessels",
        "• Direct vasodilation causes wall stretching and throbbing pain",
        "• Reduced DAO enzyme → histamine builds up in blood",
        "• Dietary histamine overload as trigger",
        "• Mast cell activation with histamine release",
        "• Estrogen stimulates mast cell degranulation",
        "",
        "Antihistamine = definitive treatment"
      ]
    },
    {
      title: "Migraine",
      color: ACCENT2, textColor: BG_DARK,
      x: 4.5, y: 1.1, w: 4.0, h: 5.9,
      content: [
        "CONTRIBUTING factor",
        "",
        "• Histamine infusion triggers migraine in 96% of migraineurs",
        "• Mast cell activation in trigeminovascular system",
        "• Histamine modulates CGRP release",
        "• Some patients partially respond to antihistamines",
        "• Red wine (histamine + tyramine) is a known trigger",
        "• Not the primary mechanism — serotonin/CGRP dominate",
        "",
        "Antihistamine = partial/adjunctive role"
      ]
    },
    {
      title: "Cluster Headache",
      color: ACCENT3, textColor: WHITE,
      x: 8.75, y: 1.1, w: 4.3, h: 5.9,
      content: [
        "HISTORICAL link (not primary)",
        "",
        "• Horton (1939): IV histamine reproduced cluster attacks",
        "• Named 'histamine headache' historically",
        "• Now understood as hypothalamic/trigeminoautonomic",
        "• Histamine not a primary pathophysiological driver",
        "• Alcohol (triggers histamine release) is a trigger",
        "• Antihistamines not effective treatment",
        "",
        "Antihistamine = NOT standard treatment"
      ]
    }
  ];

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        text: line,
        options: { breakLine: true, fontSize: idx === 0 ? 11.5 : 10.5, bold: idx === 0, color: p.textColor }
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      fontFace: "Calibri", valign: "top"
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 8 — TREATMENT SUMMARY COMPARISON
// ─────────────────────────────────────────────
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  addMidBg(s);

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    x: 0, y: 0, w: SLIDE_W, h: 1.0,
    fill: { color: "0D1B2A" }, line: { type: "none" }
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  s.addText("Treatment Summary", {
    x: 0.4, y: 0.12, w: 9, h: 0.52,
    fontSize: 30, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addText("What works — and why", {
    x: 0.4, y: 0.62, w: 6, h: 0.3,
    fontSize: 13, color: MUTED, italic: true, fontFace: "Calibri"
  });

  const txCols = [
    {
      title: "Histamine Headache",
      color: ACCENT1, textColor: BG_DARK,
      x: 0.25, w: 4.0,
      acute: ["Levocetirizine 5 mg PO", "Cetirizine 10 mg PO", "Fexofenadine 120–180 mg"],
      prevent: ["Daily antihistamine", "Low-histamine diet", "DAO enzyme supplementation", "Avoid trigger foods/allergens"],
      avoid: ["Fermented/histamine-rich foods", "Red wine", "NSAIDs (can increase histamine)"]
    },
    {
      title: "Migraine",
      color: ACCENT2, textColor: BG_DARK,
      x: 4.5, w: 4.0,
      acute: ["Triptans (sumatriptan, rizatriptan)", "NSAIDs + antiemetic", "Gepants (rimegepant)", "Ergotamines (second-line)"],
      prevent: ["Topiramate", "Propranolol / metoprolol", "Amitriptyline", "CGRP mAbs (erenumab)"],
      avoid: ["Caffeine overuse", "Sleep irregularity", "Known personal triggers"]
    },
    {
      title: "Cluster Headache",
      color: ACCENT3, textColor: WHITE,
      x: 8.75, w: 4.3,
      acute: ["O₂: 100% at 8–12 L/min", "Sumatriptan 6 mg SC", "Zolmitriptan intranasal", "Lidocaine intranasal"],
      prevent: ["Verapamil (first choice)", "Topiramate / divalproex", "Lithium (chronic type)", "Suboccipital steroid block"],
      avoid: ["Alcohol (absolute during cluster)", "Vasodilators (nitroglycerin)", "Afternoon naps"]
    }
  ];

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      x: col.x, y: 1.94, w: col.w, h: col.acute.length * 0.32 + 0.12,
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      x: col.x, y: acuteBottom + 0.32, w: col.w, h: col.prevent.length * 0.32 + 0.12,
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      fontSize: 10.5, color: LIGHT, fontFace: "Calibri"
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      x: col.x + 0.12, y: prevBottom + 0.35, w: col.w - 0.24, h: col.avoid.length * 0.32,
      fontSize: 10.5, color: LIGHT, fontFace: "Calibri"
    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 9 — CLINICAL CASE CALLBACK (40F)
// ─────────────────────────────────────────────
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  addDarkBg(s);

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    x: 0, y: 0, w: SLIDE_W, h: 1.05,
    fill: { color: ACCENT1 }, line: { type: "none" }
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    fontSize: 28, bold: true, color: BG_DARK, fontFace: "Calibri"
  });
  s.addText("40-year-old female · Internal headache · Relief with levocetirizine", {
    x: 0.4, y: 0.63, w: 12, h: 0.32,
    fontSize: 13, italic: true, color: BG_MID, fontFace: "Calibri"
  });

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    x: 0.25, y: 1.2, w: 4.0, h: 5.85,
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    { text: "Age/Sex: ", options: { bold: true, color: ACCENT1 } },
    { text: "40-year-old female\n", options: { color: LIGHT } },
    { text: "Symptom: ", options: { bold: true, color: ACCENT1 } },
    { text: "Diffuse internal headache\n", options: { color: LIGHT } },
    { text: "Response: ", options: { bold: true, color: ACCENT1 } },
    { text: "Relieved by levocetirizine\n\n", options: { color: LIGHT } },
    { text: "Key clues:\n", options: { bold: true, color: ACCENT1 } },
    { text: "• H1-antihistamine relieves pain\n", options: { color: LIGHT } },
    { text: "• Diffuse (not strictly unilateral)\n", options: { color: LIGHT } },
    { text: "• No autonomic signs (rules out cluster)\n", options: { color: LIGHT } },
    { text: "• Female > male (fits migraine/histamine)\n", options: { color: LIGHT } },
    { text: "• Perimenstrual worsening possible\n\n", options: { color: LIGHT } },
    { text: "Ask about:\n", options: { bold: true, color: ACCENT1 } },
    { text: "• Dietary triggers (wine, cheese, fish)\n", options: { color: LIGHT } },
    { text: "• Nasal symptoms / allergy history\n", options: { color: LIGHT } },
    { text: "• Hormonal/menstrual pattern\n", options: { color: LIGHT } },
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    fontSize: 10.5, fontFace: "Calibri", valign: "top"
  });

  // Diagnosis boxes
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    {
      rank: "1st", title: "Histamine Intolerance Headache",
      color: ACCENT1, textColor: BG_DARK,
      x: 4.5, y: 1.2, w: 8.55, h: 1.6,
      text: "MOST LIKELY. Antihistamine relieves pain directly = H1-mediated vasodilation. Investigate: serum DAO levels, specific IgE, histamine-free diet trial. Levocetirizine 5 mg once daily is appropriate ongoing therapy."
    },
    {
      rank: "2nd", title: "Allergic Rhinitis-Associated Headache",
      color: "7EC8C8", textColor: BG_DARK,
      x: 4.5, y: 3.0, w: 8.55, h: 1.5,
      text: "LIKELY. Sinonasal mucosal congestion causes referred cranial pressure. Look for: nasal congestion, sneezing, itchy eyes. Levocetirizine + intranasal fluticasone if confirmed."
    },
    {
      rank: "3rd", title: "Migraine with Histamine Sensitivity",
      color: "4A9A9A", textColor: WHITE,
      x: 4.5, y: 4.65, w: 8.55, h: 1.4,
      text: "POSSIBLE. Some migraineurs respond partially to antihistamines. Investigate: full migraine history, ICHD-3 criteria, triptan trial. Not mutually exclusive with histamine intolerance."
    },
    {
      rank: "Excluded", title: "Cluster Headache",
      color: "2A1010", textColor: ACCENT3,
      x: 4.5, y: 6.2, w: 8.55, h: 0.7,
      text: "EXCLUDED. Wrong sex ratio; no unilateral orbital pain; no autonomic signs; responds to antihistamine (not standard for cluster)."
    }
  ];

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      x: d.x, y: d.y, w: d.w, h: d.h,
      fill: { color: d.color }, line: { type: "none" }, rectRadius: 0.08
    });
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    });
  });
}

// ─────────────────────────────────────────────
// SLIDE 10 — CLOSING / KEY TAKEAWAYS
// ─────────────────────────────────────────────
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    {
      num: "01", color: ACCENT1,
      head: "Response to antihistamine is diagnostic",
      body: "Headache that responds to levocetirizine or cetirizine is almost certainly histamine-mediated. This is a valuable clinical clue — treat it as such, not as a coincidence."
    },
    {
      num: "02", color: ACCENT2,
      head: "Migraine and histamine overlap",
      body: "Histamine contributes to migraine but is not the primary driver. In female migraineurs with dietary triggers or perimenstrual pattern, histamine intolerance should be co-investigated."
    },
    {
      num: "03", color: ACCENT3,
      head: "Cluster headache is not antihistamine-responsive",
      body: "Despite its historical name 'histamine headache,' modern cluster headache management relies on oxygen, triptans, and verapamil — not antihistamines."
    },
    {
      num: "04", color: "AACCDD",
      head: "Histamine intolerance is underdiagnosed",
      body: "Low DAO enzyme activity, dietary histamine load, and hormonal fluctuations (estrogen-mast cell axis) converge — especially in women aged 30–50. Screen with diet trial and DAO levels."
    }
  ];

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}

// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/headache-pptx/Headache_Comparison.pptx" })
  .then(() => console.log("Done: Headache_Comparison.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/headache-pptx && node build.js 2>&1