Migraine and Headache Clinic
Headaches are among the most common pain condition in the general population, coming in various forms and caused by a wide range of factors. Headaches are typically divided into primary and secondary types: primary headaches mostly include migraine, tension headache, cluster headache, and others. Secondary headaches are usually caused by identifiable factors, such as diseases or injuries, including meningitis, brain tumors, brain haemorrhage, and more.
Migraine is a neurological, neuro-vascular, and genetic disorder. Migraine affects 1 in 7 people, and about 15% of the population suffers from it. In Israel, over 1.5 million people suffer from migraine. It is a very common disease—its prevalence is higher than that of diabetes, epilepsy, and asthma combined. The underlying mechanism of migraine is well understood, allowing us to diagnose it and provide the most fitting treatment. The disease is characterized by severe headache attacks that prevent those affected from functioning.
Migraine attacks can last up to three consecutive days and are known to be accompanied by up to 40 associated symptoms, such as nausea, dizziness, hypersensitivity to light and sound, and more. One-third of people with migraines experience attacks accompanied by an aura, which may include neurological symptoms such as visual disturbances, sensory disruptions, speech difficulties, and even weakness on one side of the body in cases of hemiplegic migraine. These attacks significantly impact daily functioning over an extended period, making migraine the second most debilitating disease in the world.
If migraine is not treated appropriately, it can progress to chronic migraine, a more severe form, with longer and more frequent attacks—eventually leading to daily headaches that are less responsive to treatment. Chronic migraine can cause structural and functional changes in the brain, which can be observed through advanced brain imaging. It can also lead to mental health disorders, including depression, anxiety, sleep disturbances, and vascular diseases. There is also a known association between migraine with aura and stroke, between migraine and chronic pain in various body areas, and more.
Migraine is a condition that leads to severe functional impairment and a significant reduction in quality of life. The Neurology & Migraine clinic offers advanced treatments provided by leading experts in the field, headed by Dr. Melikov, a neurologist and international expert in the treatment of headaches and migraines. Our ultimate goal is to help you manage migraine and chronic headaches in a way that allows you to enjoy the highest possible quality of life.
The treatments offered at The Neurology & Migraine clinic are based on advanced techniques in the field:
Advanced Treatments for Migraine Attacks
Gepants (including Nurtec ODT and Ubrelvy)
A group of advanced medications based on the blocking/inhibition of CGRP protein receptors, which are associated with blood vessel dilation, neuroinflammation, and play a role in the migraine mechanism, as well as in transmitting pain signals within the nervous system. This treatment is highly effective and acts quickly, allowing patients to return to normal functioning within 60 minutes. Its effectiveness lasts for a long period (pain relief can last up to two days after taking the medication, with no need for additional doses). Gepants are much safer than traditional painkillers and are not associated with the side effects seen with triptans. Additionally, they can be used by individuals with vascular diseases, as they do not cause vasoconstriction of arteries.
Unlike painkillers and triptans, gepants do not cause “medication overuse headaches”, which can occur with the overuse of pain medications or triptans.
In The Neurology & Migraine clinic, we also offer a variety of other treatments, including neuromodulation therapy (Nerivio), nerve blocks for occipital and trigeminal nerves, and more.
Advanced Treatments for Migraine Prevention:
This treatment is approved by the U.S. Food and Drug Administration (FDA) and the Israeli Ministry of Health. It is highly effective in preventing chronic migraine and migraine resistant to medication treatment. Botox is a toxin produced by the Clostridium botulinum bacterium, which blocks sensory nerves (such as the trigeminal nerve) and prevents the release of neuropeptides, including CGRP, that are involved in the migraine mechanism. Botox treatment has been proven to be both effective and safe. Over a million people worldwide who suffer from migraines have received this treatment, and it is considered the treatment of choice for chronic migraine.
Patients experience relief as early as the first treatment, with effectiveness increasing after additional treatments sessions. Patients typically experience a reduction in the frequency and intensity of migraine attacks and headaches, decreased need in painkillers, and a significant improvement in their quality of life. The treatment is administered by a neurologist specializing in migraine care, lasts about 15 minutes, and allows patients to resume their daily activities immediately, as there are no restrictions following the procedure.
Subcutaneous Biologic Treatment
This treatment involves monoclonal antibodies (MABs) aimed at blocking CGRP protein receptors or the CGRP ligand, which play a role in the migraine process. It is intended for preventing migraine in cases where the patient experiences weekly headaches or approximately four migraine attacks per month. The treatment is administered via subcutaneous injections once a month using an easy-to-use injection device such as Aimovig, Ajovy, or Emgality.
Biologic treatment for migraine prevention can also be delivered via intravenous infusion, providing long-lasting effects for approximately three months. Treatment with Vyepti is administered quarterly in a neurological day hospitalization setting at The Neurology & Migraine clinic.
Intravenous Biologic Treatment
This intravenous treatment with monoclonal antibodies targeting the CGRP protein is designed to prevent migraine. The treatment was developed to increase the drug’s bioavailability—the ratio between the amount of drug taken and the portion that enters the bloodstream. Treatment with Vyepti is a single intravenous infusion, ensuring 100% of the active ingredient enters the bloodstream, resulting in immediate action and lasting effects for three months. The treatment lasts approximately 30 minutes and has no impact on overall health, allowing patients to continue their daily routine immediately after. Vyepti is given quarterly as part of a neurological day hospitalization at The Neurology & Migraine clinic.
Advanced Pharmacological Treatment
Gepants (including Nurtec ODT, Qulipta)
This advanced group of medications works by blocking CGRP protein receptors, which are involved in the migraine process. The treatment is taken orally on a daily or every-other-day basis. It is specifically designed for migraines, making it much more effective and safer than traditional medications for migraine prevention like anti-depressants, or anti-epilepsy, or drugs for high blood pressure.
In the clinic, we offer a variety of other treatments, including creating a personalized migraine prevention plan based on individual migraine attack triggers.
