Background <p>Sleep disturbances are common in patients with chronic migraine, yet the clinical predictors of sleep quality in this population remain unclear. This study aimed to explore the relationship between sleep quality and clinical, psychological, and lifestyle factors in chronic migraine.</p> Methods <p>This retrospective observational study included patients with chronic migraine at a tertiary medical center in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Clinical variables included monthly headache days, pain severity, and migraine-related disability. Multiple regression analyses were used to identify predictors of sleep quality.</p> Results <p>Among the 56 participants (85.7% women, mean age 42.7 ± 13.3 years), 46 (82.1%) reported poor sleep quality (PSQI ≥ 6). In unadjusted analyses, higher pain severity (β = 0.94, <i>p</i> = 0.010), anxiety (β = 0.22, <i>p</i> &lt; 0.001), and depressive symptoms (β = 0.19, <i>p</i> &lt; 0.001) were significantly associated with poorer sleep quality. Adjusted analyses revealed that anxiety (β = 0.20, <i>p</i> = 0.001) and depressive symptoms (β = 0.17, <i>p</i> = 0.002) were significant predictors of poor sleep quality in their respective models, after adjusting for demographic and clinical variables. Participants with poor sleep quality had significantly higher anxiety (19.59 ± 13.28 vs. 9.50 ± 6.42, <i>p</i> = 0.001) and depression scores (20.59 ± 14.45 vs. 12.40 ± 7.69, <i>p</i> = 0.018) than those with good sleep quality.</p> Conclusions <p>Anxiety and depression are strongly associated with poor sleep quality in chronic migraine patients. Addressing psychological comorbidities is essential to improve sleep quality, highlighting the need for an integrated treatment approach.</p>