New figures and studies show: More and more people in Germany are suffering from the most extreme form of headache – and their quality of life is being massively destroyed.

Berlin, August 7, 2025 – More and more people in Germany are being diagnosed with cluster headaches. These occur unilaterally with extremely severe nighttime attacks of pain in the temples and eyes. It primarily affects men, but women can also suffer from this headache, the third most common type of headache after migraines and tension headaches. This is the result of a recent analysis by the BARMER Institute for Health Systems Research (bifg). While around 43,000 people were diagnosed with cluster headaches in 2010, by 2023 there were already 74,800 affected. This represents an increase of 74 percent. The number of cases among men rose from around 27,100 to almost 44,800, and among women from just over 15,900 to around 30,000. "Cluster headaches were not well known for a long time and are now receiving greater attention. And that's right. After all, the extremely painful attacks not only impair those affected's sleep, but also severely limit their overall quality of life. Tailored medical care is therefore urgently needed," says Prof. Dr. Christoph Straub, CEO of BARMER. Individualized treatment concepts are needed, which are best developed with specialists in headache centers. Conventional headache medications are not very effective for cluster headaches, but inhaling oxygen can sometimes stop an attack.
Middle-aged people are particularly affected.

According to a BARMER analysis, cluster headaches primarily affect people between the ages of 40 and 69. Between 2010 and 2023, the number of cases in this group rose from just under 26,700 to around 47,700 diagnoses. "Cluster headaches are fatal because they often begin at night, deprive people of sleep, and can occur in attacks lasting several hours. This is even more problematic if there is no opportunity for recovery during the day," says Straub.

Significant regional differences

As the BARMER analysis further shows, there are clear regional differences in the occurrence of cluster headaches. In 2023, the diagnosis was most frequently made in Bremen and Rhineland-Palatinate, with 14.4 and 12.5 affected individuals per 10,000 people, respectively, and least frequently in Mecklenburg-Western Pomerania and Saxony, with 8.3 and 8.5 per 10,000 people, respectively.

In 2010, around 1,800 people in Schleswig-Holstein suffered from it; by 2023, the number had risen to over 3,000 – an increase of 67 percent. " Cluster headaches were long underestimated, but are now rightly coming into focus. And that's right. After all, the extremely painful attacks not only disrupt sleep but also significantly impair quality of life. Tailor-made medical care is urgently needed," says Dr. Bernd Hillebrandt, regional director of Barmer in Schleswig-Holstein. Individualized treatment concepts, which are best developed with specialists in headache centers, are needed. Conventional headache medications are hardly effective, but inhaling oxygen can sometimes end an attack.

Mainly middle-aged people affected

According to a Barmer cluster primarily affect people between 40 and 69 years of age . In this age group, the number of cases increased nationwide by 78.6 percent between 2010 and 2023. " Cluster headaches are fatal because they often begin at night, deprive people of sleep, and can occur in attacks lasting several hours. This is particularly problematic when no rest is possible during the day," says Hillebrandt.

“Hellish pain with suicidal thoughts” – New studies from the Kiel Pain Clinic reveal the true face of cluster headaches

Cluster headaches are considered one of the most excruciating forms of pain. Two recent studies from the Kiel Pain Clinic now impressively demonstrate: The condition is even more serious and diverse than previously thought – and it drives many sufferers to the brink of despair.

A large-scale study of 825 patients shows that the symptoms extend far beyond the currently valid diagnostic criteria. Not only do attacks of extremely severe pain occur, but many also experience persistent pain between attacks . Furthermore, some patients experience alternating pain sides or locations—factors that have so far been ignored in the official diagnostic criteria. "Overly narrow criteria lead to patients being diagnosed and treated too late," the authors warn. Comorbid psychological disorders such as depression, anxiety, and sleep disorders are also common and further exacerbate the suffering (Göbel CH et al., Pain Ther . 2021;10(2):1121–1137).

The results of a second study involving 207 inpatients are even more dramatic. More than 70% had suffered from cluster headaches for more than five years, and over three-quarters experienced at least three attacks per day – often at night, leading to extreme exhaustion and inability to work. Almost all patients experienced severe impairments in their quality of life. Particularly alarming: Over 40% reported suicidal thoughts. "Cluster headaches not only destroy the lives of those affected, they directly threaten them," the researchers summarize (Göbel CH et al., Pain Ther . 2025;14:753–767).

Cluster headaches are more than "just" a headache. The condition exhibits a wide range of clinical manifestations and causes unimaginable psychosocial stress. The new studies make it clear: Adequate care must urgently address both the medical and the psychological and social consequences – so that those affected are no longer left undiagnosed, inadequately treated, and alone with their suffering. "Cluster headaches are excruciating agony. Many sufferers experience daily pain so unbearable that it can even lead to suicidal thoughts. Our research shows: This condition destroys lives if it is not recognized early and treated comprehensively," summarizes Prof. Dr. Hartmut Göbel, Chief Physician of the Kiel Pain Clinic, the new study results.

Sources:

https://link.springer.com/article/10.1007/S40122-025-00715-9

https://link.springer.com/article/10.1007/s40122-021-00267-8 

Recognize and effectively treat cluster headaches