Physician-led diagnosis and management of migraine, headache disorders, and chronic neurologic pain — delivered with clinical precision, academic rigor, and the longitudinal continuity that complex neurological conditions genuinely require.
Patients managing chronic or high-frequency episodic migraine with meaningful functional impairment across occupational, domestic, or social domains.
Those with treatment-refractory headache disorders who have not achieved adequate clinical response through conventional first- or second-line therapies.
Patients presenting with complex or undifferentiated neurological symptoms requiring extended clinical investigation — not a compressed, high-throughput diagnostic encounter.
Individuals seeking a fundamentally different care model — one built on physician continuity, clinical depth, and outcomes the conventional healthcare system is not structured to deliver.
Comprehensive evaluation of complex neurological presentations — including autoimmune and neuroinflammatory etiologies, refractory symptom constellations, and diagnostic uncertainty cases warranting extended physician oversight.
FDA-approved and clinically validated interventional modalities — OnabotulinumtoxinA (Botox), occipital nerve blocks, CGRP pathway therapies, and physician-administered IV infusion support.
Physician-led diagnosis and longitudinal management of chronic migraine, episodic and transformed migraine, trigeminal autonomic cephalalgias, and refractory headache disorders across the full ICHD-3 classification spectrum.
Continuous, physician-directed management for patients with chronic or recurrent neurological conditions — with individualized care architectures that adapt to clinical response, evolving comorbidities, and long-term neurological trajectory.
15 or more headache days per month — at least 8 with true migraine quality. A recognized neurological condition that rewires pain pathways over time, not simply “bad headaches.”
Insurance-accepted for this diagnosis
Fewer than 15 days/month, but individual attacks can be completely disabling. Early, precise intervention is one of the most effective ways to prevent progression to chronic migraine.
Preventive treatment often covered by insurance
Among the most painful conditions documented in medicine — one-sided pain around the eye, often accompanied by tearing and nasal symptoms, occurring in cycles over weeks or months.
Specialist evaluation is essential for this diagnosis
The most common headache type — a steady, pressing pain like a tight band around the head. Frequently coexists with migraine and often shares the same root causes.
Often coexists with migraine — combined evaluation recommended
Shooting or burning pain originating from a specific nerve rather than muscle tension or vascular changes — frequently misidentified as migraine or sinus headache.
Nerve blocks often provide rapid relief in these cases
Headache that begins after a head injury, concussion, or whiplash — real, neurological in origin, and one of the most undertreated conditions in headache medicine.
Often covered by auto or workers' compensation insurance
Migraine rarely follows a linear course. We approach every patient relationship as an evolving clinical partnership — continuously reassessing treatment efficacy and recalibrating based on real-world response data.
An initial diagnosis represents a working clinical hypothesis, not a fixed conclusion. As data accumulate across visits, we refine our diagnostic formulation and modify treatment strategy accordingly.
No patient is maintained on a therapeutic regimen that has failed to yield meaningful clinical response. We track quantifiable outcomes at every interval and recalibrate proactively — not reactively.
Escalation decisions are governed by clinical evidence, validated safety profiles, and longitudinal neurological risk calculus — not by patient preference or prevailing therapeutic trend.
OnabotulinumtoxinA · 31-site protocol
Delivered across the standardized 31-site head and neck injection paradigm at 12-week intervals. Among the most rigorously validated preventive therapies for chronic migraine.
Local anesthetic ± steroid per indication
Precision anesthetic nerve blocks targeting the greater and lesser occipital nerves — capable of interrupting an acute migraine cycle and providing sustained relief.
Suboccipital, trapezius, temporalis, SCM
Targeted myofascial injection therapy addressing pericranial and cervical trigger zones implicated in headache amplification and chronification.
Non-pharmacologic, FDA-cleared devices
An evidence-based therapeutic avenue for patients with pharmacological intolerance, contraindication, or inadequate first-line response.
Magnesium, NAD+, DHE, ketorolac-based
Physician-supervised IV infusion therapy for acute migraine rescue and neurological support — individualized to your clinical presentation.
Erenumab, Fremanezumab, Galcanezumab
The first preventive medications designed specifically around migraine's own biology, targeting the CGRP pathway directly.
Quarterly physician-led clinical evaluation
Individualized therapeutic recalibration at each encounter
Direct-access physician relationship
High-frequency, close-interval clinical monitoring
Botox every 12 weeks
CGRP pathway agent coordination and optimization
IV migraine rescue therapy
Magnesium + NAD+ support
Physician-supervised
Your first visit is designed for depth, not efficiency. We review your complete symptom chronology, therapeutic history, and functional burden before forming any clinical impression.
Applying ICHD-3 diagnostic criteria, we classify your specific headache phenotype, neurological profile, and clinical burden — establishing a defined therapeutic direction.
Your treatment plan is constructed from evidence-validated modalities selected specifically for your diagnosis, clinical history, and therapeutic goals.
We monitor outcomes at defined intervals and execute the therapeutic adjustments your case requires. Neurological care, here, is a sustained relationship.
Every therapeutic recommendation is preceded by a thorough, individualized clinical evaluation.
Treatment decisions are governed by clinical evidence, validated safety data, and long-term neurological risk calculus — not by patient preference or trend-driven prescribing.
We adhere to conservative therapeutic sequencing as a foundational standard, escalating only when objective clinical indicators support doing so.
Clinical restraint is part of our care philosophy.
Most patients arrive after exhausting standard therapeutic options without achieving durable relief. Our clinical objective is specific and measurable: a meaningful, sustained reduction in migraine frequency, functional burden, and neurological suffering — with outcomes that hold over time.
A clinically significant reduction in migraine days per month
Restored occupational and functional capacity across professional, domestic, and social domains
Stable, longitudinally maintained symptom control
An ongoing clinical partnership with a physician of record who maintains comprehensive familiarity with your case
Neurological health that improves — and holds — over time
The same physician at every visit — someone who knows your full history, not just your chart
Appointments designed around complex cases — unhurried, attentive, and genuinely thorough
Treatment refinements made over time, based on how you're actually responding
A practice small enough to know you, with the clinical depth to make a real difference
Care that continues long after the first improvement — because lasting results take time
Schedule a comprehensive neurological consultation with Dr. Monti. Every engagement begins with a complete clinical evaluation. Insurance verification is available upon request prior to your first appointment.
Our clinicians specialize in migraine medicine and neurological care. Complex conditions deserve unhurried attention — and that is precisely what every patient relationship here is built on.
MD · Board-Certified in Internal Medicine
Dr. Monti founded Monti Institute on a conviction born from clinical practice: that chronic migraine and complex neurological disorders require more than a compressed appointment and a formulaic prescription.
PA-C · Physician Associate
Sean Kump brings concentrated expertise in migraine therapeutics, interventional headache medicine, and complex neurological case management.
FNP-BC · Advanced Practice Provider
A board-certified Family Nurse Practitioner with over 15 years of experience in acute care and hospital medicine, and a native Nevadan.
MSN, APRN, CPNP-PC
A board-certified nurse practitioner specializing in neurological wellness and integrative care, centered on whole-patient health.
Director of Operations
Megan manages clinical operations at Monti Institute, overseeing specialized workflows and an unhurried, pristine patient experience.
Coverage varies by plan and service.
Verify Insurance CoverageAll care begins with physician evaluation.
Precision medicine requires precise language. The following definitions support informed, substantive conversations between patient and physician — not to replace one.
Calcitonin Gene-Related Peptide (CGRP) is a neuropeptide released from trigeminal nerve terminals that plays a central role in migraine pathophysiology, producing vasodilation, neurogenic inflammation, and the sensitization of pain pathways that characterize a full migraine episode.
The CGRP pathway has become one of the most significant pharmacological targets in modern migraine medicine — gepants block the receptor directly, and anti-CGRP monoclonal antibodies provide monthly or quarterly preventive coverage.
A documented clinical indication is a formally recorded, evidence-based rationale that justifies a specific medical or aesthetic intervention for a specific patient at a specific point in their clinical course. No procedure at Monti Institute is performed without one.
For Botox for chronic migraine, this means a confirmed diagnosis, documented inadequacy of prior preventive treatments, and physician-recorded clinical reasoning supporting the intervention for that patient.
The Superficial Musculoaponeurotic System (SMAS) is the fibromuscular layer connecting the facial muscles to the overlying dermis, functioning as the structural scaffold of the mid- and lower face.
As the SMAS loses integrity with age, overlying soft tissue structures migrate inferiorly, producing jowl formation and effacement of the mandibular border.
The content on this website is for informational purposes only and does not constitute medical advice, diagnosis, or treatment, and does not establish a provider-patient relationship. Always consult a qualified healthcare professional regarding your individual health circumstances. In a medical emergency, call 911. · Full Medical Disclaimer · Privacy Policy