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Note: For complete details, please review product monographs at and regularly review current Health Canada advisories, warnings and recalls at: for the most up to date information.) Table 4: Treatment of B 12 deficiency (adapted from Means 2021) 27 Note: Intranasal administration is generally not used

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Significant brain alterations in pain-processing areas, abnormal pain modulation, central sensitization, cortical hyperexcitability, neurogenic inflammation, and ongoing neuroinflammation are central to the development and persistence of chronic migraines (35)