Conditions we treat
Migraine and headache
Board-certified headache specialist care for kids, teens, and young adults with frequent, disabling headaches, especially when previous treatments haven’t worked.
Try it
When does migraine become “chronic migraine”?
All migraine is a chronic disease: a lifelong tendency that comes and goes. “Chronic migraine” is a specific term for migraine that is both frequent and longstanding, with headache on 15 or more days a month for more than 3 months. It affects up to about 2% of teens and 1 to 2% of adults.
Each square is one day in a 30-day month.
Even a handful of migraine days can mean missed school and cancelled plans. Good rescue treatment matters here.
Migraine is more than a painful headache. It’s a recurring headache that comes with brief neurologic and autonomic symptoms that come and go with the pain. Those symptoms are the key difference between migraine and a tension-type (muscle) headache.
Typical features: throbbing pain, on one side of the head in adults and often both sides in kids, lasting hours (4 or more untreated in adults, 2 or more in kids), and worse with activity, along with nausea or sensitivity to light and sound. Many people also have brain fog, dizziness, irritability, and fatigue, sometimes starting before the pain and lingering after.
Why it matters
Headache is one of the most common chronic pain problems in children and teens, affecting about 1 in 4. Migraine is a big part of that: about 1 to 3% of children ages 3 to 7, 4 to 11% of children ages 7 to 11, and 8 to 23% of teens by age 15. Before puberty, boys and girls are affected equally. After puberty, migraine is two to three times more common in girls.
Migraine is the second most disabling condition in the world. For young people, it can mean missed school, dropped sports, lost friendships, and a shrinking life.
Yet most young people with migraine are under-treated: managed with over-the-counter medications, told to “stay hydrated,” or placed on long waiting lists for specialists.
Headache medicine is its own specialty. Dr. Windsor is board-certified in headache medicine and pediatrics, fellowship-trained in pediatric pain medicine at Boston Children’s Hospital, and the only board-certified headache specialist in South Carolina focused on teens and young adults. At Prisma Health, he founded the Southeast’s first division combining pediatric pain, headache, and concussion medicine.
Headaches we treat
- Episodic and chronic migraine
- New daily persistent headache (NDPH)
- Menstrual migraine
- Migraine with aura and vestibular migraine
- Post-traumatic headache after concussion
- Tension-type and cervicogenic (neck) headache
- Occipital neuralgia
- Medication overuse headache
- TMJ-related headache and facial pain
- Abdominal migraine and cyclic vomiting
Getting the diagnosis right
Good treatment starts with the right diagnosis. Many young people have more than one kind of headache at once, such as migraine plus a daily background headache from the neck, the jaw, or medication overuse. Each one needs its own plan.
We take a detailed history, examine the head, neck, and jaw, and review every medication that’s been tried, at what dose, and for how long. We also look for contributors others miss: sleep, the menstrual cycle, POTS, hypermobility, anxiety, ADHD, and school stress.
Most young people with headaches don’t need an MRI. We order imaging when the history or exam points to it.
Call 911 or go to the emergency room for a sudden, severe “worst ever” headache; headache with fever and a stiff neck; new weakness, numbness, confusion, trouble speaking, or vision loss; or a headache after a head injury that keeps getting worse.
Call your doctor promptly for headaches that wake your child from sleep with vomiting, headaches that are worse lying down or with coughing or straining, or a new headache pattern that keeps getting worse over days to weeks.
How we treat it
Most of our patients have already tried several treatments. If you’ve seen multiple providers and are still struggling, it isn’t because nothing can be done. It’s because headache medicine is a specialty, and there are many more tools than most people have been offered.
We also move quickly. Rapid evaluations and treatment mean fewer missed school and work days, and Saturday visits in Greenville let many patients come in without missing school or work at all.
A rescue plan that works
The right medication, at the right dose, taken early, with clear limits that prevent medication overuse headache and a plan for school.
Prevention
Preventive medications chosen for each patient, including newer migraine-specific options when they fit, and supplements where the evidence supports them.
Nerve blocks
In-office occipital, superficial cervical plexus, auriculotemporal, and suprazygomatic maxillary nerve blocks to stop a long attack, break a cycle of daily headache, or treat headache from the neck and face.
Trigger point therapy
Trigger point injections and other trigger point treatments for tight muscles in the head, neck, and shoulders that set off or worsen headaches.
Jaw and neck
TMJ injections for headache driven by the jaw, and neck strengthening and posture work for headache that starts in the neck.
Botox
Botox injections for chronic migraine when other treatments haven’t worked. We help with prior authorizations and appeals.
Neuromodulation devices
Drug-free devices that calm migraine pain pathways, used on their own or alongside medication.
Sleep treatment
Treating insomnia, irregular schedules, and other sleep problems, one of the strongest drivers of frequent headache.
Executive skills and healthy habits
Help with planning, routines, and follow-through from our occupational therapist, so the sleep, meal, hydration, and activity habits that prevent headaches actually happen.
Acupuncture
Medical acupuncture from a board-certified physician acupuncturist, for prevention and for patients who want to rely less on medication.
Mental health and ADHD treatment
Anxiety, depression, ADHD, and stress treated in the same plan with our psychiatric nurse practitioner, including biofeedback and relaxation training.
School and activity
Written plans, accommodation letters, and a realistic return to full school days, sports, and activities.
Kids, teens, and young adults
Migraine looks different at different ages. Young children often have shorter attacks, pain on both sides of the head, or belly pain and vomiting instead of headache. Teens add hormonal changes, heavy school loads, sports, and less sleep.
Young adults often fall through the cracks: too old for pediatric headache clinics and new to adult ones. We see patients up to age 30, so care can continue through high school, college, and the first years of work with the same team.
We also see select older adults with difficult headache conditions, usually after they’ve seen a neurologist.
Often travels with
Headache rarely travels alone in our patients.
Questions families ask
What is chronic migraine?
All migraine is a chronic disease, but “chronic migraine” is a specific diagnosis: headache on 15 or more days a month for more than 3 months, with migraine features on at least 8 of those days. It affects up to about 2% of teens and 1 to 2% of adults. It’s the pattern most likely to disrupt school, work, and daily life, and it calls for a preventive plan, not just rescue medicine.
How is migraine different from a regular headache?
Migraine is a recurring headache with neurologic and autonomic symptoms that come and go with the pain, such as nausea, sensitivity to light and sound, dizziness, and brain fog. The pain is often throbbing, one-sided in adults (often both sides in kids), lasts hours, and gets worse with activity. A tension-type headache is usually a steady, pressing pain without those other symptoms.
Can taking pain medicine too often make headaches worse?
Yes. Using simple pain relievers on 15 or more days a month, or triptans on 10 or more days, can lead to medication overuse headache, where the treatment itself keeps headaches going. Untangling this is a routine part of our care.
Does my child need an MRI?
Usually not. Most young people with headaches have a normal exam and a typical pattern, and an MRI won’t change the treatment. We order imaging when something in the history or exam points to it.
What is new daily persistent headache?
A headache that starts on a clearly remembered day, often after an illness, and doesn’t go away for more than 3 months. It can be stubborn, and it usually needs a combination of treatments.
Do you treat headaches after a concussion?
Yes. Post-traumatic headache is one of the most common concussion symptoms to linger. We treat it along with the neck pain, sleep problems, and dizziness that often come with it. Read about concussion care.
Can teens get Botox for migraine?
Botox is FDA-approved for chronic migraine in adults. In teens, specialists use it off-label when other treatments haven’t worked. Insurance coverage isn’t guaranteed, but we help with prior authorizations and appeals.
When should my child or I see a headache specialist?
When headaches are frequent, cause missed school, work, or activities, need pain medicine more than a couple of days a week, or haven’t improved with treatment from a pediatrician, primary care doctor, or neurologist.
What should we bring to the first visit?
A list of every headache medication and preventive treatment tried, with doses and how long each was used, plus a headache diary if you have one. Prior imaging and notes help too, but don’t wait to book if you don’t have them.
Chronic migraine and medication overuse headache definitions from the International Classification of Headache Disorders, 3rd edition (ICHD-3). Disability ranking from the Global Burden of Disease Study. Childhood headache prevalence from King, Chambers, et al., Pain 2011; migraine prevalence by age from pediatric epidemiology reviews. Chronic migraine prevalence from the American Migraine Prevalence and Prevention Study (Lipton 2011, adolescents; Buse 2012, adults) and a global systematic review (Natoli 2010).
Ready to start?
Book online in a few minutes. No referral needed. We see children, teens, and young adults up to age 30 in Greenville, Charlotte, and by telehealth in SC and NC.