The relationship between sleep and migraine is enigmatic. Patients with migraine report poorer sleep and have a higher risk of some sleep disorders. Sleep disruption is commonly retrospectively reported as a trigger or prodromal symptom. During an attack, patients may try to sleep for its perceived analgesic effect, yet fatigue dominates the postdrome. These complex bidirectional relationships between sleep and migraine are influenced, but not explained, by shared risks. Neuroscientific evidence suggests a shared pathophysiology via the hypothalamus and its influence on neuropeptides. The aim of this chapter is to review clinically relevant studies on sleep and migraine, summarize potential shared pathophysiologic mechanisms, and suggest how to address sleep complaints in migraine patients.