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In fact, there are no NICE guidelines relating to Pernicious Anaemia, just a Clinical Knowledge Summary which has a glaring error in it (weve pointed this out to NICE who are considering revising it)

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It acts as a nonselective agonist of one of several MCRs

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The mechanism likely parallels headache, relating to shifts in blood sugar, hydration status, and caloric intake rather than a direct pharmacological effect on vestibular function