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      // ====== TITLE PAGE ======
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          new TextRun({
            text: "ASSESSMENT OF DEHA PRAKRITI AND ITS ASSOCIATION WITH MIGRAINE",
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            text: "A CROSS-SECTIONAL OBSERVATIONAL STUDY",
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        children: [new TextRun({ text: "Department of Kayachikitsa / Kriya Sharir | [Institution Name]", size: 24, font: "Times New Roman", italics: true })]
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      // ====== SECTION 1: INTRODUCTION ======
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          text: "Migraine is one of the most prevalent neurological disorders worldwide, affecting approximately 1 billion individuals globally and ranking as the second leading cause of disability among all neurological conditions (Global Burden of Disease Study, 2019). It is characterised by recurrent attacks of unilateral, pulsating headache of moderate to severe intensity, lasting 4-72 hours, often associated with nausea, vomiting, photophobia, and phonophobia. Despite extensive modern biomedical research, the precise pathophysiology of migraine remains incompletely understood, and treatment strategies continue to be inadequate for a significant proportion of patients.",
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          text: "Ayurveda, the ancient Indian system of medicine, offers a unique and individualistic approach to health and disease through the concept of Deha Prakriti (body constitution). The term 'Prakriti' literally means 'nature' or 'original form', and in the context of Ayurvedic medicine, it refers to the inherent psycho-somatic constitution of an individual determined at the time of conception. Deha Prakriti is governed by the relative predominance of the three biological humours - Vata, Pitta, and Kapha - collectively known as Tridoshas.",
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          text: "According to classical Ayurvedic texts such as Charaka Samhita (Vimana Sthana 6/15) and Sushruta Samhita, an individual's Deha Prakriti determines their disease susceptibility, physiological responses, and prognosis. A person predominantly of Vataja Prakriti is considered more susceptible to disorders caused by Vata vitiation, while Pittaja Prakriti individuals are predisposed to Pitta-predominant conditions. Classical texts correlate migraine (Ardhavabhedaka) with Vata-Pitta or Tridoshaja pathogenesis.",
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          text: "In Ayurvedic literature, migraine headache finds its closest correlation with 'Ardhavabhedaka' (half-sided headache). Acharya Charaka described it as Vata-Kaphaja Vyadhi, while Acharya Vagbhata considered it predominantly Vataja. Acharya Sushruta classified it as a Tridoshaja condition. The symptomatology described - namely paroxysmal attacks, unilateral location, pulsating nature, aggravation by movement, and association with nausea - closely parallels the modern International Classification of Headache Disorders (ICHD-3) diagnostic criteria for migraine.",
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          text: "The concept that Deha Prakriti determines disease predisposition is well-established in Ayurveda. However, scientific validation of the association between specific Prakriti types and migraine through systematic cross-sectional studies remains sparse. Modern genomic and phenotypic studies have begun to validate the biological basis of Prakriti, demonstrating significant differences in gene expression, metabolic profiles, and immune parameters among the three Prakriti types. This opens a new avenue for integrating Ayurvedic constitutional medicine with contemporary neurology.",
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          text: "The present cross-sectional observational study is therefore designed to systematically assess the Deha Prakriti of migraine patients using a validated Prakriti assessment tool and to identify any statistically significant association between specific Prakriti types and the occurrence, frequency, severity, and pattern of migraine. Such findings would contribute to personalised Ayurvedic management and provide a foundation for further interventional research.",
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      // ====== SECTION 2: REVIEW OF LITERATURE ======
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      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "2.1 Deha Prakriti in Ayurvedic Classics", bold: true })] }),
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          text: "The concept of Prakriti is elaborated extensively in classical Ayurvedic texts. Charaka Samhita (Vimana Sthana 8/95-98) delineates seven types of Prakriti based on the predominance of individual doshas or their combinations: Vataja, Pittaja, Kaphaja, Vata-Pittaja, Vata-Kaphaja, Pitta-Kaphaja, and Sama (tri-doshic balance). Sama Prakriti individuals are considered the healthiest, with strong immunity (Bala) and longevity (Ayu). Sushruta Samhita and Ashtanga Hridayam provide corroborating descriptions of constitutional characteristics.",
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          text: "Charaka Samhita (Vimana Sthana 6/15) explicitly states that a person with Vataja Prakriti is more susceptible to diseases caused by vitiated Vata. Similarly, Pittaja Prakriti individuals are predisposed to Pitta-type diseases, and Kaphaja Prakriti to Kapha-type diseases. This fundamental principle underpins the rationale for studying the association of Deha Prakriti with specific disease conditions including migraine.",
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          text: "Physical characteristics associated with Vataja Prakriti include lean body frame, dry skin, irregular appetite, variable sleep patterns, quick mental activity, anxiety proneness, and sensitivity to cold. Pittaja Prakriti individuals are characterised by medium build, sharp intellect, strong digestion, heat intolerance, and irritability. Kaphaja Prakriti manifests as heavy build, smooth skin, slow digestion, sound sleep, and strong endurance.",
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          text: "In Ayurvedic nosology, headache disorders are classified under Shiroroga (diseases of the head). Ashtanga Hridayam enumerates ten types of Shiroroga including Ardhavabhedaka, Suryavarta, Shankha, and others. Ardhavabhedaka (literally 'that which pierces half the head') corresponds closely with migraine in modern medicine, characterised by unilateral, paroxysmal, severe headache with associated symptoms.",
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          text: "According to Acharya Charaka (Sutrasthana 17/26), Ardhavabhedaka is caused by vitiated Vata and Kapha affecting Shiras (head), producing pain in half the head at intervals of a fortnight or a month. Acharya Vagbhata (Uttaratantra 23) described Ardhavabhedaka as primarily Vataja in origin. Sushruta Samhita classified it as Tridoshaja, implicating all three doshas. The commentator Chakrapani has equated 'Migraine Vedna' (pain) with Ardhavabhedaka.",
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          text: "Migraine types based on Doshic predominance include: (1) Vataja type - severe throbbing/piercing pain, associated with constipation, dry skin, sensitivity to cold, triggered by stress, fasting, and irregular sleep; (2) Pittaja type - burning quality of pain, photophobia, nausea, vomiting, heat sensitivity, triggered by hot/spicy foods and sunlight; (3) Kaphaja type - dull heavy pain, nausea, lethargy, triggered by rich foods, excessive sleep, and sedentary habits.",
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          text: "Migraine is classified by the International Headache Society (IHS) under the International Classification of Headache Disorders, 3rd Edition (ICHD-3) into: Migraine without aura, Migraine with aura, Chronic migraine, and other subtypes. It affects approximately 12-15% of the general population, with a female-to-male ratio of approximately 3:1. In India, the prevalence ranges from 9-25% in various population-based studies.",
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          text: "The pathophysiology of migraine involves cortical spreading depression, trigeminovascular activation, neurogenic inflammation, and central sensitisation. Serotonergic, dopaminergic, and calcitonin gene-related peptide (CGRP) pathways are implicated. Genetic susceptibility, hormonal factors, sensory triggers, and autonomic dysregulation all contribute to migraine pathogenesis - several of which overlap conceptually with Vataja and Pittaja constitutional predispositions.",
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          text: "Recent scientific research has begun to validate the biological basis of Prakriti. Genomic studies have identified differential gene expression patterns among Prakriti types, with Pitta Prakriti individuals showing upregulation of genes related to metabolic activity and inflammatory pathways, while Vata Prakriti subjects show patterns associated with neurological activity. Metabolomic profiling and immunological studies have demonstrated measurable phenotypic differences corresponding to Ayurvedic constitutional categories.",
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          text: "Rotti et al. demonstrated that Kaphaja Prakriti subjects had significantly increased CD25 (activated B cells) and CD56 (natural killer cells) levels, suggesting stronger humoral immunity compared to other Prakriti groups. Pitta Prakriti individuals showed higher CD14 levels, indicating greater monocyte activity. Vata Prakriti was associated with comparatively lower immune parameters, consistent with the classical description of poor Bala (immunity) in Vataja individuals.",
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          text: "In terms of disease-Prakriti associations, studies have shown that Vata-predominant Prakriti is significantly associated with Amavata (rheumatoid arthritis), neurological conditions, and anxiety disorders. Pittaja Prakriti has been linked to inflammatory and metabolic disorders. Kaphaja Prakriti individuals show susceptibility to respiratory, musculoskeletal, and metabolic syndrome-related conditions. A case-control study by Bhalerao et al. (2023) found Vata Prakriti had an odds ratio of 23.92 (95% CI: 13.08-43.73) for Amavata, demonstrating the strong predictive value of Prakriti assessment for disease susceptibility.",
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          text: "Studies integrating Ayurveda and yoga for migraine management (Pise et al., 2018) assessed Prakriti as a baseline variable and found that Vata-Pitta Prakriti was the predominant constitution among migraine patients undergoing Ayurvedic therapeutic purgation (Virechana), yielding significant symptomatic improvement. This suggests a clinically meaningful relationship between Prakriti and migraine that warrants direct observational investigation.",
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          text: "Several standardised Prakriti assessment questionnaires have been developed and validated. The Council of Scientific and Industrial Research (CSIR) has developed a validated Prakriti questionnaire covering physical attributes, physiological responses, psychological traits, and behavioural tendencies. Other validated tools include the Mysore Classification System and institutional Prakriti Pariksha questionnaires developed by AIIMS and NIA, Jaipur. These tools assess parameters such as body frame, skin texture, hair quality, appetite, digestion, sleep patterns, temperament, memory, and stress response.",
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      }),

      // ====== SECTION 3: RESEARCH GAP AND NEED ======
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          text: "Despite the extensive classical Ayurvedic literature linking Prakriti to disease susceptibility, and the growing scientific evidence validating the biological basis of Prakriti, there is a significant paucity of published cross-sectional observational studies that specifically and systematically investigate the association between Deha Prakriti and migraine. The following research gaps have been identified:",
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      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "No dedicated cross-sectional study specifically examining the distribution of Deha Prakriti among migraine patients versus headache-free controls using a validated Prakriti assessment tool could be identified in the published literature.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "The correlation between specific Prakriti types and migraine characteristics (frequency, duration, severity, associated symptoms, trigger factors, and aura) has not been systematically studied.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "The demographic pattern of Prakriti distribution among migraine sufferers across different age groups and sexes remains uncharacterised in the Indian population.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "There is a lack of data that could guide personalised Ayurvedic management protocols for migraine based on the patient's constitutional Prakriti.", font: "Times New Roman", size: 24 })] }),

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          text: "Need of the Present Study: Given the high prevalence of migraine, the limitations of current pharmacological management, and the rich theoretical basis in Ayurveda linking Prakriti to Ardhavabhedaka, there is a compelling need to conduct a systematic observational study to: (a) document the Prakriti distribution in migraine patients; (b) determine whether specific Prakriti types are significantly overrepresented among migraine sufferers; and (c) explore whether Prakriti is associated with migraine characteristics. The findings would provide evidence-based inputs for personalised Ayurvedic treatment protocols and contribute to the growing body of integrative medicine research.",
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      }),

      // ====== SECTION 4: RESEARCH QUESTION ======
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          text: "\"Is there a statistically significant association between Deha Prakriti (Vataja, Pittaja, Kaphaja, or dual/mixed Prakriti) and the occurrence, frequency, severity, and clinical characteristics of migraine (Ardhavabhedaka) in patients attending an Ayurveda outpatient department?\"",
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      }),

      // ====== SECTION 5: AIMS AND OBJECTIVES ======
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      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "5.1 Aim", bold: true })] }),
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          text: "To assess Deha Prakriti in patients diagnosed with migraine (Ardhavabhedaka) and to determine the association between Prakriti type and the clinical features of migraine.",
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      }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "5.2 Primary Objectives", bold: true })] }),
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      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To evaluate the association between specific Prakriti types and the occurrence of migraine.", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "5.3 Secondary Objectives", bold: true })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To correlate Deha Prakriti with the frequency of migraine attacks (number of headache days per month).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To correlate Deha Prakriti with the severity of migraine attacks as assessed by the Visual Analogue Scale (VAS) and the Migraine Disability Assessment Score (MIDAS).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To correlate Deha Prakriti with specific migraine characteristics including laterality, duration, associated symptoms (nausea, vomiting, photophobia, phonophobia), and aura.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To assess the relationship between Prakriti and common migraine trigger factors (dietary, lifestyle, stress, hormonal, environmental).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "To document the demographic profile (age, sex, occupation, dietary habits) of migraine patients in relation to their Prakriti.", font: "Times New Roman", size: 24 })] }),

      // ====== SECTION 6: EXPECTED OUTCOMES ======
      new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "6. EXPECTED OUTCOMES", bold: true })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "The study is expected to demonstrate a significantly higher prevalence of Vataja and/or Vata-Pittaja Prakriti among migraine patients, consistent with classical Ayurvedic texts that attribute Ardhavabhedaka predominantly to vitiated Vata-Pitta.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Specific Prakriti types are expected to correlate with specific migraine patterns - Vataja Prakriti with higher frequency and trigger-related attacks (stress, fasting, cold), Pittaja Prakriti with heat-triggered and photophobia-dominant attacks, and Kaphaja Prakriti with nausea-predominant, slower onset attacks.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "A significant association between Prakriti and MIDAS scores (migraine-related disability) is anticipated.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "The study will generate a Prakriti-based clinical profile of migraine patients that can serve as the basis for future interventional studies using Prakriti-specific Ayurvedic therapies.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "The findings will contribute to evidence-based integration of Ayurvedic constitutional medicine into personalised headache management protocols.", font: "Times New Roman", size: 24 })] }),

      // ====== SECTION 7: MATERIALS AND METHODS ======
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      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "7.1 Study Design", bold: true })] }),
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        children: [new TextRun({ text: "Cross-Sectional Observational Study", font: "Times New Roman", size: 24, bold: true })]
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          text: "A cross-sectional observational study design is employed wherein the Deha Prakriti and migraine characteristics of enrolled patients will be assessed simultaneously at a single point in time (or over a defined enrolment period), without any intervention or manipulation of variables. This design is appropriate for determining the prevalence of Prakriti types among migraine patients and for examining associations between constitutional type and disease characteristics.",
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        })]
      }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "7.2 Study Setting and Duration", bold: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Setting: Outpatient Department (OPD) of Kayachikitsa, [Name of Ayurveda College and Hospital]", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Duration of Study: 12-18 months (from [Date] to [Date])", font: "Times New Roman", size: 24 })] }),
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      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "7.3 Sample Size", bold: true })] }),
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          text: "Sample size will be calculated using the formula for cross-sectional studies: n = Z^2 x P(1-P) / d^2, where Z = 1.96 (95% confidence level), P = estimated proportion of Vataja Prakriti among migraine patients based on prior literature (approximately 50-60%), and d = 0.05 (acceptable margin of error). Based on this, a minimum sample of 100-120 migraine patients is estimated. An additional 15% will be added for dropouts and incomplete data, bringing the target sample to approximately 120-140 patients.",
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        })]
      }),

      // ====== SECTION 8: SELECTION CRITERIA ======
      new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "8. SELECTION CRITERIA OF PATIENTS", bold: true })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "8.1 Diagnostic Criteria", bold: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 120 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({
          text: "Patients will be diagnosed with migraine using dual criteria - modern and Ayurvedic - to ensure scientific validity and classical correlation.",
          font: "Times New Roman", size: 24
        })]
      }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "8.1.1 Modern Diagnostic Criteria (ICHD-3, 2018)", bold: true, italics: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 60 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({ text: "Migraine Without Aura (ICHD-3 Code 1.1) - Diagnosis requires:", font: "Times New Roman", size: 24, bold: true })]
      }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "At least 5 attacks fulfilling criteria B-D", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Headache with at least 2 of the following characteristics: (a) unilateral location; (b) pulsating quality; (c) moderate or severe pain intensity; (d) aggravation by or causing avoidance of routine physical activity", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "During headache, at least 1 of the following: (a) nausea and/or vomiting; (b) photophobia and phonophobia", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Not better accounted for by another ICHD-3 diagnosis", font: "Times New Roman", size: 24 })] }),

      new Paragraph({
        spacing: { before: 120, after: 60 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({ text: "Migraine With Aura (ICHD-3 Code 1.2) - will also be included if fulfilling ICHD-3 criteria for typical aura with migraine headache.", font: "Times New Roman", size: 24 })]
      }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "8.1.2 Ayurvedic Diagnostic Criteria (Ardhavabhedaka)", bold: true, italics: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 60 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({ text: "Based on classical descriptions from Charaka Samhita (Sutrasthana 17/26), Ashtanga Hridayam (Uttaratantra 23), and Sushruta Samhita, the following clinical features will be used for Ayurvedic correlation:", font: "Times New Roman", size: 24 })]
      }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Ardhashirasa Shoola: Pain confined to half the head", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Paroxysmal nature: Attacks recurring at intervals (Paksha, Masa)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Tivra Vedana: Severe, excruciating pain", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Sphurana / Toda: Throbbing / stabbing quality", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Akshikarna involvement: Eye and ear involvement during attack", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Chardi / Arati: Nausea and/or vomiting", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Prakaasha Asahishnuta / Shabda Asahishnuta: Photophobia / phonophobia", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "8.2 Inclusion Criteria", bold: true })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients of either sex, aged 18-60 years.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients diagnosed with migraine satisfying ICHD-3 diagnostic criteria (with or without aura).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients presenting with at least 2 migraine episodes in the preceding 3 months.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients who have not taken any preventive anti-migraine medication in the preceding 4 weeks (to avoid confounding Prakriti assessment by drug effects).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients willing to give written informed consent for participation in the study.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients able to understand and respond to the Prakriti assessment questionnaire (in the regional language or Hindi/English).", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "8.3 Exclusion Criteria", bold: true })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients with secondary headache disorders attributable to intracranial pathology (tumour, abscess, subdural hematoma, hydrocephalus), identified by clinical examination and/or neuroimaging.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients with other primary headache disorders such as cluster headache, tension-type headache (TTH), trigeminal autonomic cephalalgias, or medication-overuse headache as the primary diagnosis.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients with chronic migraine (more than 15 headache days per month for more than 3 months) where significant Prakriti modification due to prolonged illness is anticipated.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients with significant systemic illness: uncontrolled hypertension, diabetes mellitus with complications, renal failure, hepatic disease, thyroid disorders, or autoimmune conditions.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Pregnant and lactating women (hormonal changes significantly alter Prakriti assessment and migraine pattern).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients currently on long-term corticosteroids, immunosuppressants, hormonal contraceptives, or other medications known to significantly influence Dosha balance.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients who have undergone major surgery or hospitalisation in the preceding 3 months.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients with significant psychiatric comorbidities (schizophrenia, active psychosis, severe depression) that may interfere with accurate questionnaire completion.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients who have had Panchakarma procedures (Virechana, Basti, Nasya, Raktamokshana, Vamana) in the preceding 3 months.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Patients unwilling or unable to give informed consent.", font: "Times New Roman", size: 24 })] }),

      // ====== SECTION 9: CRITERIA FOR ASSESSMENT ======
      new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "9. CRITERIA FOR ASSESSMENT", bold: true })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "9.1 Assessment of Deha Prakriti", bold: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 120 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({
          text: "Deha Prakriti will be assessed using the following structured approach:",
          font: "Times New Roman", size: 24
        })]
      }),
      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.1.1 Tool: Validated Prakriti Assessment Questionnaire", bold: true, italics: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 120 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({
          text: "A standardised and validated Prakriti Pariksha questionnaire will be used, as developed and validated by the National Institute of Ayurveda (NIA), Jaipur / or the institutional validated tool. The questionnaire covers 60-100 parameters across the following domains:",
          font: "Times New Roman", size: 24
        })]
      }),

      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Sharira (Physical) parameters: Body frame, body weight, skin texture, complexion, hair quality, eyes, nails, teeth, sweat pattern, voice, gait, appetite, thirst, digestion, bowel habits, sleep patterns, physical endurance, sexual vigour, lifespan.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Manasa (Psychological) parameters: Memory type, intellectual capacity, emotional temperament, anger, fear, attachment, mental endurance, response to stress, personality type.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Behavioural / Social parameters: Eating habits, activity level, social interactions, decision-making style, speech pattern.", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.1.2 Scoring and Classification", bold: true, italics: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Each parameter will be scored for its Vata, Pitta, and Kapha values on a Likert scale.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Total Vata, Pitta, and Kapha scores will be calculated.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Final percentage scores: Final percentage score for each Dosha = (Total points obtained for that Dosha / Maximum possible points) x 100.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "The predominant Dosha (scoring > 50% and significantly higher than the others) will determine the Prakriti classification.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Dual Prakriti: If two doshas score significantly higher than the third (combined >70%), a dual Prakriti will be assigned (e.g., Vata-Pittaja).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Sama Prakriti: If all three doshas are within 10% of each other, the patient will be classified as Sama Prakriti.", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "9.2 Assessment of Migraine Characteristics", bold: true })] }),
      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.2.1 Migraine Frequency", bold: true, italics: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Number of migraine headache days per month (3-month recall)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Graded as: Low frequency (< 4 days/month), Moderate (4-8 days/month), High (> 8 days/month)", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.2.2 Migraine Severity - Visual Analogue Scale (VAS)", bold: true, italics: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "A 10 cm visual analogue scale (0 = no pain; 10 = worst imaginable pain)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Grade 0: No pain (0); Grade I: Mild (1-3); Grade II: Moderate (4-6); Grade III: Severe (7-10)", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.2.3 Migraine Disability Assessment (MIDAS)", bold: true, italics: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "The validated MIDAS questionnaire (Stewart et al., 2000) assesses headache-related disability over 90 days across work, household activities, and social/leisure activities.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Grading: Grade I (0-5): Little or no disability; Grade II (6-10): Mild disability; Grade III (11-20): Moderate disability; Grade IV (>21): Severe disability.", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.2.4 Clinical Characteristics Assessment", bold: true, italics: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Laterality: Unilateral / bilateral / alternating", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Duration of each attack: < 4 hours / 4-24 hours / 24-72 hours", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Quality of pain: Throbbing / pressing / stabbing / burning", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Aura: Presence / absence; type (visual, sensory, speech)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Associated symptoms: Nausea, vomiting, photophobia, phonophobia, osmophobia", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_3, children: [new TextRun({ text: "9.2.5 Trigger Factor Assessment", bold: true, italics: true })] }),
      new Paragraph({
        spacing: { before: 80, after: 60 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({ text: "A structured checklist of triggers will be administered, categorised as:", font: "Times New Roman", size: 24 })]
      }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Dietary: Fasting, specific foods (cheese, chocolate, caffeine, alcohol, spicy/oily food)", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Lifestyle: Irregular sleep, physical exertion, dehydration, suppression of natural urges", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Psychological: Stress, anxiety, emotional upset", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Environmental: Bright light, loud noise, strong odours, weather changes, heat/cold", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Hormonal: Menstruation, oral contraceptive use (in female patients)", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "9.3 Ayurvedic Dosha Assessment of Migraine (Nidana-Panchaka)", bold: true })] }),
      new Paragraph({
        spacing: { before: 120, after: 60 },
        alignment: AlignmentType.JUSTIFIED,
        children: [new TextRun({ text: "For each patient, the Ayurvedic assessment of the migraine condition itself (not Prakriti) will be performed using the Nidana Panchaka (five-fold diagnostic framework):", font: "Times New Roman", size: 24 })]
      }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Nidana (Causative factors): Ahara (diet), Vihara (lifestyle), Manasika (psychological) factors", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Purvarupa (Prodromal features): Photophobia, mood changes, stiffness, yawning", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Rupa (Clinical features): Pain characteristics, associated symptoms", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Upashaya-Anupashaya (Relieving and aggravating factors): Response to rest, cold, heat, food", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Samprapti (Pathogenesis): Doshic predominance assessment based on symptom analysis", font: "Times New Roman", size: 24 })] }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "9.4 Data Collection Tools (Summary)", bold: true })] }),
      // Table: Assessment Tools
      new Table({
        width: { size: 9026, type: WidthType.DXA },
        rows: [
          new TableRow({
            tableHeader: true,
            children: [
              new TableCell({ width: { size: 3000, type: WidthType.DXA }, shading: { type: ShadingType.CLEAR, fill: "1F3864" },
                children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "Assessment Domain", bold: true, color: "FFFFFF", font: "Times New Roman", size: 22 })] })] }),
              new TableCell({ width: { size: 3000, type: WidthType.DXA }, shading: { type: ShadingType.CLEAR, fill: "1F3864" },
                children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "Tool / Method", bold: true, color: "FFFFFF", font: "Times New Roman", size: 22 })] })] }),
              new TableCell({ width: { size: 3026, type: WidthType.DXA }, shading: { type: ShadingType.CLEAR, fill: "1F3864" },
                children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "Outcome Measure", bold: true, color: "FFFFFF", font: "Times New Roman", size: 22 })] })] }),
            ]
          }),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Deha Prakriti", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Validated Prakriti Questionnaire (NIA/Institutional)", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Vataja / Pittaja / Kaphaja / Dwandwa / Sama", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Migraine Diagnosis", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "ICHD-3 Criteria + Clinical Examination", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Migraine with/without aura", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Pain Severity", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Visual Analogue Scale (VAS)", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "0-10 numeric score", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Migraine Disability", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "MIDAS Questionnaire", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Grade I-IV disability score", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Trigger Factors", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Structured Trigger Checklist", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Dietary / Lifestyle / Stress / Environmental / Hormonal", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Ayurvedic Correlation", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Nidana Panchaka Assessment", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Doshic predominance in current episode", font: "Times New Roman", size: 22 })] })] }),
          ]}),
          new TableRow({ children: [
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Demographic Data", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Structured Case Record Form (CRF)", font: "Times New Roman", size: 22 })] })] }),
            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Age, sex, occupation, diet, lifestyle", font: "Times New Roman", size: 22 })] })] }),
          ]}),
        ]
      }),

      new Paragraph({ heading: HeadingLevel.HEADING_2, children: [new TextRun({ text: "9.5 Statistical Analysis", bold: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Descriptive statistics: Frequency, percentage, mean, standard deviation for all variables.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Chi-square test / Fisher's exact test: To assess association between Prakriti type (categorical) and migraine occurrence and characteristics (categorical).", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "ANOVA / Kruskal-Wallis test: To compare VAS and MIDAS scores across different Prakriti groups.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Odds Ratio (OR) with 95% CI: To quantify the strength of association between each Prakriti type and migraine.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Pearson / Spearman correlation: To assess correlation between continuous Prakriti scores and continuous migraine variables.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Significance level: p < 0.05 will be considered statistically significant.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Statistical software: SPSS Version 25.0 / IBM Statistics or equivalent.", font: "Times New Roman", size: 24 })] }),

      // ====== SECTION 10: ETHICAL CONSIDERATIONS ======
      new Paragraph({ heading: HeadingLevel.HEADING_1, children: [new TextRun({ text: "10. ETHICAL CONSIDERATIONS", bold: true })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Ethical clearance from the Institutional Ethics Committee (IEC) will be obtained prior to commencement.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Written informed consent (in the local language) will be obtained from all participants after explaining the nature, purpose, benefits, and potential risks of the study.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Participation will be entirely voluntary; withdrawal will be permitted at any time without prejudice to treatment.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "Patient confidentiality will be maintained through anonymisation of data. No personal identifiers will appear in published data.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "As this is a purely observational study with no intervention, there is no anticipated risk to participants.", font: "Times New Roman", size: 24 })] }),
      new Paragraph({ numbering: { reference: "bullets", level: 0 }, children: [new TextRun({ text: "The study will be conducted in accordance with the Declaration of Helsinki (2013 revision) and ICMR National Ethical Guidelines for Biomedical and Health Research (2017).", font: "Times New Roman", size: 24 })] }),

      // ====== SECTION 11: REFERENCES ======
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      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Charaka Samhita of Agnivesha. Vimana Sthana 6/15; 8/95-98; Sutra Sthana 17/26. Acharya YT, editor. Chaukhambha Surbharati Prakashan; 2014.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Sushruta Samhita. Uttara Tantra. Jadavji Trikamji, editor. Chaukhambha Sanskrit Sansthan; 2012.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Ashtanga Hridayam of Vagbhata. Uttara Tantra 23. Srikanthamurthy KR, translator. Krishnadas Academy; 2012.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019. Lancet. 2020;396(10258):1204-22.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Bhalerao SS, et al. A case-control study for exploring the association of Prakriti with Rheumatoid Arthritis (Amavata). PMC10505973. J Ethnopharmacol. 2023.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Pise MV, et al. Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache. J Ayurveda Integr Med. 2018;9(3):208-12.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Rotti H, et al. Determinants of Prakriti, the human constitution types of Indian traditional medicine and its correlation with gene expression profiling. J Transl Med. 2014;12:248.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Prasher B, et al. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. J Transl Med. 2008;6:48.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Prakash GP, Sharma D, Pandey S. Evidence Basis Study of Migraine in Ayurveda 'Ardhavbhedaka'. Int J Med Public Health. 2024;14(4):103-107.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Stewart WF, et al. Development and testing of the Migraine Disability Assessment (MIDAS) questionnaire to assess headache-related disability. Neurology. 2000;54(5 Suppl 2):S20-8.", font: "Times New Roman", size: 22 })] }),
      new Paragraph({ numbering: { reference: "numbers", level: 0 }, children: [new TextRun({ text: "Kulkarni R, et al. Prakriti-based medicine: A step ahead. J Ayurveda Integr Med. 2010;1(2):100-2.", font: "Times New Roman", size: 22 })] }),
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