Background <p>Bony projections arising from the ligament, tendon, or joint capsule site rarely seen in radiographs are generally termed enthesophytes. One such incidental finding noted prevalently in cephalometric radiographs of young individuals is occipital spurs or external occipital protuberance. The present study aims to assess the prevalence of occipital spurs in lateral cephalograms and correlate their type and shape with age and sex.</p> Material and methods <p>This retrospective observational study assessed the prevalence of occipital spurs in a sample of 986 lateral cephalograms. Two trained maxillofacial radiologists under the supervision of experienced maxillofacial radiologists classified the type and shape of occipital spurs according to age group and sex. Data were entered into an Excel sheet and then statistically analysed with a statistical significance set at a 95% confidence interval.</p> Results <p>Cohen’s kappa statistics revealed a strong inter- and intra-observer agreement (0.83 and 0.81, respectively). The prevalence of occipital spurs was 23.32%. Females exhibited longer occipital spurs and the smooth or flat spurs were most prevalent between both sexes. Analysis according to age group revealed that smooth type was commonly observed among all the assessed age groups. Additionally, the present study identified the presence of ossification of ligamentum nuchae (ONL) in 13 individuals.</p> Conclusion <p>Occipital spurs are notable incidental findings on lateral cephalograms, particularly prevalent in younger age groups. The aetiology of these bony protrusions remains unclear. While often asymptomatic, understanding their potential for enlargement and associated clinical implications is crucial for appropriate patient management.</p>