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Stress triggers muscle tension in the neck, shoulders, and scalp that directly causes both symptoms

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This stability extends to reconstituted solutions, which can maintain potency for several weeks when properly refrigerated

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Published in final edited form as: Ann N Y Acad Sci

In general cyanocobalamin isn't retained as long as hydroxocobalamin so maintenance dosing tends to be more frequent - think in the states they tend to do loading doses as daily for one or two weeks followed by weekly for a few months and then monthly