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First, the dose used in the protocol (1,000 micrograms of methylcobalamin weekly) is far above what a multivitamin provides

The API must be accompanied by a valid Certificate of Analysis which verifies the APIs quality and compliance with regulatory standards and conducts routine and rigorous third-party quality testing to check for potency, sterility, quality and contamination to ensure patient safety in compliance with state and United States Pharmacopeia standards

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This is one reason the condition often goes undetected for longer than it should

Other specific considerations Patients with migraines should be aware that dehydration and electrolyte shifts early in treatment can trigger or worsen migraines