Vitamin B12 deficiency, “A Problem That’s Easy to Miss”

May 4, 2019

The role of vitamin B12 is underappreciated by many doctors. This week, The Wall Street Journal published a full-page article on vitamin B12 deficiency, which can be of great help to many of the two million readers of this newspaper. The survey quoted in the article shows that only one third of patients with this deficiency are diagnosed within a year, 22% within 1-2 years, 20% within 2-5 years 10% within 5-10 years and 14% after more than 10 years. It took several years for the author of the WSJ article to be diagnosed.

A confounding problem is that even if the doctor orders a vitamin B12 level, the widely used blood test is inaccurate. While the normal range is from 200 to 1,200 (depending on the laboratory), cases of severe deficiency have been described with levels of up to 700. You may have a good amount of vitamin B12 circulating in the blood, but it may not be getting into the cells where it is needed for the normal functioning of the nervous system, blood formation, and other functions. Many patients with a level above 200 are told by their doctors that their level is normal, but it should be at least over 400 and even better if it is above 500. We do have two additional blood tests that can confirm if the body needs additional vitamin B12 – homocysteine and methylmalonic acid levels but they are rarely utilized.

It is well worth your time to read the entire WSJ article.

I’ve written several times about the dangers of long-term treatment with PPIs, acid reducing drugs, such as Prilosec and Nexium. Among other side effects, they interfere with the absorption of vitamin B12 and other vitamins and minerals.

As far as headaches, vitamin B12 deficiency can be a contributing factor and taking vitamin B12 along with other B vitamins can relieve migraines.

Pain of facial neuralgia was found to be due to vitamin B12 deficiency in case studies of 17 patients and their pain resolved with vitamin B12 injections.

As the WSJ article suggests, many patients with neurological symptoms require regular injections rather than taking vitamin B12 pills. A couple of hundred of our patients come for monthly vitamin B12 injections, often along with an infusion of magnesium – another very common and highly underdiagnosed deficiency. It is not only migraines and other headaches that improve, but also fatigue, dizziness, and other symptoms.

Here is an old article from the Educational Materials section of our website.

Written by
Alexander Mauskop, MD
Continue reading
July 3, 2026
Alternative Therapies
Essential Oils Can Change Your Brain
The science of essential oils and the brain is still young, but the findings so far are more compelling than many people realize. Brain imaging studies show that common scents like rose, lavender, peppermint, and lemon produce measurable changes in brain structure, brain activity, and pain processing. These studies are small and preliminary, and essential oils are not a substitute for medical treatment. But the evidence suggests that what we smell can influence the brain in real, physical ways
Read article
June 30, 2026
Alternative Therapies
Why I Ask You to Breathe Out When I Inject Botox
Incorporating slow, prolonged exhalation into procedures such as Botox injections offers a practical, evidence‑informed way to reduce discomfort and anxiety. By aligning the injection with the out‑breath, we engage parasympathetic and attentional mechanisms that help the brain process pain signals less intensely. This simple breathing cue does not replace careful technique or other comfort measures, but it complements them and gives patients an active role in their own pain control. As research on breathing and pain continues to grow, integrating this kind of mind–body strategy into migraine care becomes an increasingly important part of modern neurology.
Read article
June 29, 2026
Migraine status
Intravenous treatment for severe migraine
When you need intravenous drugs, in an ER or our office
Read article
Insights from Dr. Alexander Mauskop on headaches and migraines
Subscribe to the Blog.
Subscribe
Subscribe