Transnasal Butorphanol in the Treatment of Acute Migraine

We studied transnasal butorphanol (Stadol NS·) for pain relief during acute migraine in a multicenter, randomized, double-blind, placebo controlled trial using ambulatory patients at 10 geographically diverse headache centers. Patients were volunteer adults diagnosed with migraine with or without aura by International Headache Society criteria. One hundred fifty-seven patients completed the study. We treated the pain of one headache in each patient with either transnasal butorphanol (n=107) or transnasal placebo (n=50). Pain relief, pain intensity, nausea, vomiting, and effect on function were measured periodically. Adverse experiences were documented. Global assessments were made at follow-up. With butorphanol, migraine pain was reduced from moderate, severe, or incapacitating to slight or absent for 35 patients (33%) within 30 minutes, for 50 patients (47%) within 1 hour, and for 76 (71%) within 6 hours, compared to 2 (4%) 8 (16%) and 15 (30%) respectively for placebo. Side effects were prominent, though confounded by the migraine. The most common side effects, compared to placebo, were dizziness (58% vs 4%), nausea and/or vomiting (38% vs 18%), and drowsiness (29% vs 0%). We conclude that transnasal butorphanol is a useful analgesic for the pain of acute migraine. Its prominent side effects and low self reinforcement rate may limit its usefulness in some patients, while increasing its appropriateness for others.     

An examination of racial/ethnic disparities in children's oral health in the United States

Objective: To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care. Methods: Data were from the 2007 National Survey of Children's Health, for children 2‐17 years (n = 82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model‐based survey‐data‐analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors. Results: Unadjusted results show large racial/ethnic oral health disparities. Compared with non‐Hispanic White people, Hispanic and non‐Hispanic‐Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0‐4.6), 2.2 (2.0‐2.4), respectively], lack preventive care [ORs 1.9 (1.8‐2.0), 1.4 (1.3‐1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3‐1.7), 1.4 (1.3‐1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non‐Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5‐1.8) and 1.2 (1.1‐1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9‐1.1), 1.1 (1.1‐1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non‐Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6‐0.7)]. Conclusions: Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.