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There is no real evidence to suggest that there are toxicity levels with B12

Persistent symptoms localized to one region of the tendon

Headache at higher per-injection doses community sources describe dose-splitting or reducing to resolve

Good Practice Its important for me to acknowledge that there are brilliant Practices in the UK that know their patients need their B12 injections and are either still administering them or are prescribing ampoules and equipment to make it possible for patients to self treat

The Research on Combined Treatment Studies comparing combination treatments show success rates approaching 90% - far higher than either treatment alone

They flag it when it persists across multiple visits without progression to specificity