Actually, flyback topography is the most common for high voltage, low current applications, such as your app. Efficiency is not the highest, but since the power is low, you do not lose much. In most high voltage flyback converters, a transformer, rather than just an inductor, is used. A small 120:6 volt transformer usually does a nice job for nixies.
Yes with flyback the turns ratio can be lower than what you'd normally require for a given output voltage by a factor of 10 or so, a 6:120V transformer will give just over 1kV out when a 6V pulse is applied to the primary, although this only applies to very low current applications such as a spark gap, if you need a regulated HV supply it's best to go on 4 to 6 times the turns ratio.
When the current is suddenly interrupted in the primary, a high voltage pulse is created across the primary because the transformer's inductance tries to keep the current flowing and the voltage is boosted again by the turns ratio of the transformer.
Another way of looking at it is to put the following facts together:
When current flows through a coil it generates a magnetic field,
When a coil is exposed to a change in magnetic field a voltage is induced in the coil, the faster the rate of change of the magnetic field and the more turns on the coil, the higher the induced voltage.
So when the current is applied to the primary a magnetic field is created. When the current is abruptly interrupted, the magnetic field surrounding the coil suddenly disappears, exposing the coil to a rapid change in magnetic field which generates a theoretically infinite voltage. In practice the voltage will be limited by, the speed at which the current is interrupte, the coil's resistance and parasitic capacitance which will cause a damped oscillation.