Q: Dr. Eppley, I am interested surgical reduction of the occipital nob. I have a large bump on the bottom of the back of my head that causes constant pain and headaches. It hurts to sleep on it and wearing protective head wear at work is almost impossible. I have read that you do a reduction of the occipital knob. Is this strictly a cosmetic procedure or can it be deemed a medical issue for insurance coverage?
A: The occipital knob deformity is an abnormally large hump of bone at the bottom of the occipital bone in the midline. Why it develops more prominently in some men than others is not known. It has become more of an aesthetic issue today since more men shave their head or have very closely cropped hairstyles.
Tthe size of the bony knob can be a source of discomfort when flexing the head backwards or in certain headwear/headgear. This is also where some of the neck muscles attach and the large hump of bone probably signals strong muscular attachments as well. The occipital knob can be reduced by burring it down through a small horizontal incision over it. This is a cosmetic procedure and not one covered by insurance.
Dr. Barry Eppley