During the medieval period in Europe, skull imagery became associated with power and strength, and was often depicted in art and jewelry as a reminder of the transience of life. This was particularly true during the time of the Black Death (also known as the Plague), when death was a constant presence in people's lives, and the skull became a symbol of both fear and resilience. Knights and warriors would often wear skull-adorned rings and pendants as a symbol of their power and strength in the face of death.

In the Renaissance period, skull imagery became popular in art and jewelry, and was often used to decorate rings, pendants, and other jewelry items. This was partly due to the interest in death and the macabre that was popular at the time, as well as the influence of the Vanitas movement, which used imagery of skulls and other symbols of death to remind people of their own mortality. The famous Dutch artist, Rembrandt, also depicted skulls in several of his works, further popularizing the trend.