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The root cause of a vitamin B12 deficiency can be one of several things

You may experience a cluster (one-sided, severe, intensive, piercing pain), tension (mild to moderate, constant pain that feels like a tight band squeezing your head), or migraine (severe, pulsating pain that is usually one-sided) headache that usually develops either within 3 hours (immediate) or 512 hours after drinking

This may be due to lack of production of a hormone by the kidneys (erythropoietin or EPO) that stimulates production of red blood cells in the bone marrow, but can also be due to other factors (such as loss of blood in the intestines)

Is CPT 90471 an add-on code