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It is thought that the large-scale celebration of birthdays in Europe began with the cult of Mithras, which originated in Persia but was spread by soldiers throughout the Roman Empire. Before this, such celebrations were not common; and, hence, practices from other contexts such as the Saturnalia were adapted for birthdays. Because many Roman soldiers took to Mithraism, it had a wide distribution and influence throughout the empire until it was supplanted by Christianity.

Birthday celebrations were rare during the Middle Ages but saw a resurgence with the advent of the Reformation. During this period, they were seen as a good way to transfer customs from the saint's days to other dates not linked to the newly repudiated veneration of saints.

Even today, the celebration of birthdays is not universal in the West; in addition to those people preferring name day celebrations, Jehovah's Witnesses do not celebrate either, considering them to be pagan festivals along with Christmas and Easter. Many adults loathe celebrating it as it reminds them that they are getting progressively older. And in some activities that are not year-round, birthday acknowledgements may be discouraged because of some birthdays not falling during the season.

Birthday CakeIn most English-speaking countries it is traditional to sing the song Happy Birthday to You to the honored person celebrating his birthday. The Happy Birthday Song melody is thought to be the most frequently sung melody in the world. Similar songs exist in other languages such as "Lang zal hij/zij leven" (and several others) in Dutch, "Zum Geburtstag Viel Glück" in German, "Feliz Cumpleaños" in Spanish, "Sto lat" in Polish and "Tanti Auguri a te" in Italian. This happens traditionally at a birthday party while someone brings a birthday cake into the (often darkened) room.

The birthday cake is traditionally highly decorated, and typically covered with lit candles when presented; the number of candles often equals the age of the person. The person whose birthday it is makes a silent wish and then blows out the candles; if done in one breath, the wish is supposed to come true, but only if the person keeps the wish to himself (or herself). It is also common for the "birthday boy" or "birthday girl" to cut the initial piece of the cake as a newlywed couple might with a wedding cake. Birthday cakes have been a tradition dating back as far as the Middle Ages when the English would conceal symbolic items such as gold coins, rings and thimbles inside their cakes. Each item was associated with a prediction. For example, a person finding a gold coin in a birthday cake would supposedly become wealthy where a person discovering a thimble would never marry.

For special birthdays and for when the number of candles might be considered impractical or a fire hazard, special candles might be substituted for the many individual candles. These candles are in the shape of a numeral; for example, on the fifth birthday there may be one candle on the cake in the shape of the numeral 5, and on the fiftieth birthday there may be two candles on the cake, one in the shape of the numeral 5 followed by the other in the shape of the numeral 0.