Anti-nausea medications such as metoclopramide are commonly used in migraine management for control of nausea and emesis. The most commonly used anti-emetics are metoclopramide, promethazine, and prochlorperazine. All three medications are dopamine blocking agents and have the potential to cause movement disorders that are disabling and permanent.

The Leaf research database was used to analyze drug induced tardive dyskinesia (TD) patients (ICD-9: 333.85 and ICD-10: G24.01) and migraine  (ICD-9: 346.00-346.93, ICD-10: G43.001-G43.D1) at University of Washington Medical Center. Patients were analyzed based on their use of metoclopramide, and other  antiemetics.

495 patients had subacute dyskinesia and of those, 54 patients had migraine diagnosis.  We also looked at 66,086 patients with migraine and 22,795 used metoclopramide. 2,011 were prescribed metoclopramide specifically for migraine. 47 patients were identified as having migraines and subacute drug induced dyskinesia. Out of 19 patients with previous use of metoclopramide, 17 carried diagnosis of TD. 5 patients out of the 17 with diagnosis of TD had presumed cause from metoclopramide. Upon detailed chart review only one patient with migraine met TD criteria from use of metoclopramide. It was used for indigestion for 1.5 years.

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We conclude that tardive dyskinesia (TD) from metoclopramide in migraine patients is very rare. In analysis of our database of close to 5 million unique patients and detailed chart review, only one patient met the diagnostic criteria for TD in the setting of  prolonged metoclopramide use. There are multiple dopamine blocking drugs and cumulative duration and dosage is the primary risk for TD in genetically susceptible individuals. Medical providers treating patients with migraine need to be aware of potential risk of tardive dyskinesia when using these drugs.