BACKGROUND: Migraine is a primary headache disorder that affects more than 1 billion individuals globally and imposes a significant disability burden on society. Although migraine patients commonly experience poor sleep quality, the relationship between migraine and sleep is not yet fully understood. This study therefore aimed to determine the association between sleep quality and migraine severity. METHODS: A comparative cross-sectional study was conducted with 1,399 participants across all regions of Saudi Arabia from August to October 2023 using standardized questionnaires. Participants were categorized into patients with migraine and non-migraine patients, according to the International Headache Society (IHS) criteria. This study utilized The Migraine Disability Assessment Scale (MIDAS) and Pittsburgh Sleep Quality Index (PSQI) to evaluate migraine severity and sleep quality, respectively. RESULTS: The prevalence of migraine was 25%, while poor sleep quality was evident in 42.4% of the patients. No significant difference in PSQI scores was observed between patients with migraine and non-migraine patients ( CONCLUSION: These findings suggest a notable correlation between poor sleep quality and increased migraine severity, emphasizing the importance of addressing sleep disturbance as a potential strategy to mitigate migraine severity and improve patient outcomes.