Comorbidity of Temporomandibular Disorders, Anxiety, Depression, and Poor Sleep Quality in Episodic and Chronic Migraine: A Cross-Sectional Observational Study.

Background/Objectives: This study investigated the comorbidity between temporomandibular disorders (TMD) and migraine, distinguishing episodic migraine (EM) from chronic migraine (CM), and examined whether TMD presence in migraine patients is associated with more severe clinical or psychological features. Methods: A cross-sectional sample of 120 participants was evaluated, including 40 headache-free controls, 40 EM patients, and 40 CM patients. Demographic and clinical information was obtained through structured interviews. Participants completed the Headache Impact Test (HIT-6), State-Trait Anxiety Inventory (STAI), State-Trait Depression Questionnaire (ST-DEP), and Pittsburgh Sleep Quality Index (PSQI). Prevalence ratios (PR) analyzed the association between TMD and migraine and between TMD and migraine subtypes. Among migraine patients, headache frequency, medication use, headache impact, anxiety/depression symptoms, and sleep quality were compared between those with and without TMD. Results: TMD was significantly more common in migraine patients compared to controls (78.8% vs. 20.0%; PR = 3.94; 95% CI: 2.10-7.40). CM patients also showed a higher TMD prevalence than EM patients (95.0% vs. 62.5%; PR = 1.52; 95% CI: 1.18-1.95). Myalgia-related and mixed TMD were the most frequent subtypes. Migraine patients with TMD had increased headache frequency and higher acute medication intake compared to those without TMD. However, the presence of TMD was not associated with greater headache impact, anxiety, depression, or poorer sleep quality. Conclusions: Patients with migraine are almost four times more likely to present with TMD than individuals without headache, with an even stronger association observed in CM. Although TMD is associated with a greater headache burden, our findings suggest that it may not be accompanied by worse psychological or sleep outcomes.