Background <p>Primary and secondary headaches are a common complaint in neurology. Nonetheless, headache care remains suboptimal for various reasons. This study aimed to assess the training and expertise in headache medicine among young neurologists in Germany.</p> Methods <p>From January 2023 to September 2024, we conducted a national, cross-sectional survey among neurology residents and young neurologists in Germany. Participants completed a questionnaire assessing self-reported training experience, knowledge of headache diagnosis and treatment and compliance to treatment guidelines. Data were analyzed using descriptive statistics and group comparisons based on training status. </p> Results <p>A total of 93 participants (73 residents and 20 consultants, male = 44, 33.4 ± 4.8 years) were included. Most participants (89.2%) regularly treated headache patients, predominantly in emergency settings. While knowledge was highest for frequent primary headaches, deficits were evident for rare and secondary headache syndromes. Significant differences in knowledge were observed according to prior headache training. Although 67.4% of participants were aware of treatment guidelines, only 26.1% of participants have read them. 96.8% of participants considered headache training important, yet only 46.7% of participants felt well-trained. Lack of supervision (74.3%) and teaching (64.9%) were key barriers to education. Significant gaps in knowledge and adherence to guidelines were identified, particularly for medication overuse headache and cluster headache. Notably, headache medicine ranked lowest in perceived prestige among neurological subspecialties.</p> Conclusions <p>Early-career German neurologists demonstrated sufficient knowledge of common primary headaches, however deficiencies remained for rare primary and secondary headache disorders. Improved, structured headache training during residency may improve guideline adherence and optimize patient care.</p>