Buffalo Hump

Overview

A buffalo hump is a rounded pad of extra fat that builds up at the back of the neck, just below the hairline and between the shoulders. Doctors also call it a dorsocervical fat pad — 'dorsocervical' simply means the back of the neck area. It feels soft and squishy rather than hard, and it can grow slowly over months or years. The hump itself is usually harmless and is mostly a cosmetic concern. However, it can sometimes be a sign of an underlying health issue, such as a hormone imbalance or a side effect of certain long-term medicines, so it is worth having it checked by a doctor.

Yes, it is fairly common. Most cases are seen in people who carry extra weight around the middle of the body. It is also seen in people who take steroid-type medicines for a long time and in some people living with HIV, particularly with older types of HIV treatment. Because it is common and usually harmless, many people simply notice it and live with it comfortably.

It can affect adults of any age and either sex. It is more likely in people with excess weight around the waist, people taking long-term steroid-type medicines for conditions such as asthma, arthritis or inflammatory conditions, and people with a hormone condition affecting cortisol. It can occasionally occur in children, usually alongside weight gain or long-term steroid medicine use.

Symptoms

Common symptoms

• A visible, rounded swelling at the base of the neck between the shoulders
• The pad feels soft and fatty rather than hard or fixed
• A thicker-looking neck, or a change in how collars, ties and necklaces fit
• Mild stiffness or aching in the neck and shoulders
• In some people, the hump can make the neck feel heavy or restrict how far the head turns comfortably

Symptoms in children

• A soft pad at the back of the neck, often noticed by a parent or carer
• Often seen alongside weight gain or a rounder face and tummy
• In children taking long-term steroid-type medicines, this can be a side effect
• Children may feel self-conscious about how it looks, so gentle reassurance helps

Symptoms in older adults

• The hump may develop gradually alongside age-related weight changes
• It may be noticed alongside other signs such as easy bruising, thin skin or muscle weakness, which are worth mentioning to a doctor
• Neck stiffness from the hump can add to existing joint or spine problems
• Long-term steroid medicine use, common in older adults with inflammatory conditions, is a frequent cause

Causes

Main causes

• Extra weight around the middle of the body — this is the most common reason
• Cushing's syndrome, where the body makes or receives too much of the hormone cortisol
• Long-term use of steroid-type medicines, such as those used for asthma, arthritis or inflammatory conditions
• Changes in body fat distribution linked to some long-term HIV treatments, especially older types
• Rarely, other hormonal or genetic conditions that affect how the body stores fat

Risk factors

• Carrying extra weight around the waist and upper back
• Taking steroid-type medicines for more than a few months
• Having a condition that raises cortisol levels
• A family tendency to store fat around the neck and upper back
• Living with HIV, particularly on long-term treatment

When to see a doctor

See a doctor urgently if:

• The hump is getting bigger quickly or has become hard
• You have new high blood pressure, easy bruising, or purple stretch marks
• You feel very tired, weak, or thirsty all the time
• You take steroid-type medicines and feel suddenly unwell — do not stop the medicine yourself, but seek medical advice straight away

Book a routine appointment if:

• You have noticed a hump at the back of your neck and would like to know what it is
• It is affecting how your clothes fit or how you feel about your appearance
• You have neck or shoulder stiffness that you think is related
• You have been on steroid-type medicines for a long time and want your treatment reviewed

Diagnosis

A doctor will usually start by looking at and gently feeling the hump. They will ask about your weight history, your medicines (especially steroid-type medicines), and any other symptoms such as bruising, tiredness or changes in blood pressure. If they suspect a hormone problem, they may arrange some simple tests. In many cases, the cause is clear from the examination and history alone, and no further tests are needed.

Tests that may be done

• A blood pressure check and a blood sugar check
• Blood tests to measure the hormone cortisol and related hormones
• A urine test collected over 24 hours to measure cortisol levels
• A saliva test taken late at night, when cortisol should naturally be low
• A 'suppression' test, where you take a tablet in the evening and have a blood test the next morning to see how your body responds
• A scan, such as an ultrasound, CT or MRI, if the doctor needs a clearer picture of the area

What to expect at your appointment

Most of the checks are quick and painless. Some tests, such as the 24-hour urine collection or the suppression test, need a little planning around your day, so ask your doctor or pharmacist what to expect and whether you need to change anything beforehand. Results usually come back within days to a couple of weeks. Your doctor will explain what they mean and whether any treatment or monitoring is needed.

Treatment

Treatment depends on the cause. If the hump is linked to weight around the middle, gentle lifestyle changes can help over time. If it is caused by a medicine or a hormone condition, the focus is on reviewing or treating that cause. The hump itself rarely needs to be removed for medical reasons — most people do not need any procedure at all.

Self-care at home

• Keep a note of any new symptoms, such as bruising, tiredness or thirst, to share with your doctor
• Wear comfortable, loose collars if the area feels tight or tender
• Try gentle neck and shoulder stretches to ease stiffness
• If you take a steroid-type medicine, never stop or change it on your own — speak to your doctor first
• Ask your pharmacist or doctor for a medicines review if you have been on long-term treatment

Medical treatments

There is no medicine that specifically melts the hump away. Instead, doctors aim to treat the underlying cause. If a steroid-type medicine is the likely cause, your doctor may be able to adjust or change your treatment plan — but only under their guidance, because stopping these medicines suddenly can be dangerous. If a hormone condition such as Cushing's syndrome is found, it is usually managed by a specialist team using a range of treatments. Extra weight around the middle is best addressed with steady, realistic changes to food and activity, and your doctor or a dietitian can support you with this.

When is surgery considered?

Removal of the fat pad is rarely needed and is only considered when the hump is causing real problems, such as neck discomfort or significant distress about appearance. Options can include liposuction (a procedure that suctions out fat) or, less often, surgery. Doctors usually prefer to treat any underlying cause first, because the hump can come back if the cause is still there. Any decision about a procedure should be discussed carefully with a specialist.

Living with this condition

Most people live comfortably with a buffalo hump. It may change how your neck looks and how some clothes fit, and you may get mild stiffness. Simple adjustments — softer collars, supportive pillows, and gentle movement — usually make a real difference to day-to-day comfort.

Lifestyle tips

• Aim for regular, gentle activity you enjoy, such as walking or swimming
• Build some strength and stretching into your week to support your neck and shoulders
• Take breaks from screens and long periods in one position
• Keep up with routine health checks, such as blood pressure
• Note how your body changes over time and share anything new with your doctor

Diet and exercise

There is no special diet that targets a buffalo hump specifically. A balanced way of eating and regular movement can help reduce extra weight around the middle over time, which may shrink the hump gradually. Big, sudden changes are hard to keep up — small, steady habits work better. If you are unsure where to start, ask your doctor or pharmacist about local diet and activity support services.

Mental health and emotional wellbeing

Changes in how your body looks can affect how you feel about yourself, and it is completely understandable to find that upsetting. Some people feel self-conscious or low about it. These feelings are valid and worth talking about — with a friend, your doctor, or a counsellor. If you ever feel hopeless or have thoughts of harming yourself, reach out for crisis support straight away: contact your local emergency number or a local crisis helpline, or speak to someone you trust who can stay with you.

Prevention

You cannot always prevent a buffalo hump, especially if it is linked to a hormone condition or a medicine you need. But some steps can lower the chance of it developing, or stop it getting bigger: keeping to a healthy weight, staying active, and having any long-term steroid-type medicine reviewed regularly by your doctor.

Screening programmes

There is no routine screening programme for a buffalo hump. It is usually noticed during a normal check-up or when you see your doctor about something else. If you have been on steroid-type medicines for a long time, your doctor may check your blood pressure, blood sugar and bone health as part of your regular review.

Complications

If left untreated

• If the cause is a hormone condition such as Cushing's syndrome, leaving it untreated can lead to high blood pressure, high blood sugar, weaker bones and a higher chance of infections
• Neck stiffness or discomfort may continue or slowly worsen
• Ongoing worry about appearance can affect confidence and mood
• If a cause is missed, the hump may keep growing larger

Long-term outlook

The outlook is generally good. Most buffalo humps are harmless fat pads and do not need treatment. When there is an underlying cause, finding and managing it usually helps — and often the hump improves or stops growing. Even in the less common cases where treatment is needed, there is a lot that doctors can do. With a simple check-up and the right support, most people manage very well.

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