diff --git a/backend/src/db/client.ts b/backend/src/db/client.ts
index a97e0f7..56f6707 100644
--- a/backend/src/db/client.ts
+++ b/backend/src/db/client.ts
@@ -9,7 +9,7 @@ const client = createClient({ url });
 
 export const db = drizzle(client);
 
-// Auto-run migrations on import (self-healing database)
+// Auto-run migrations (self-healing database)
 async function runMigrations() {
   const migrations = [
     { name: "image_url", sql: "ALTER TABLE medications ADD COLUMN image_url TEXT" },
@@ -28,5 +28,5 @@ async function runMigrations() {
   }
 }
 
-// Run migrations immediately
-runMigrations().catch(console.error);
+// Export promise so server can await it before starting
+export const migrationsReady = runMigrations();
diff --git a/backend/src/index.ts b/backend/src/index.ts
index 13b4131..1e55fea 100644
--- a/backend/src/index.ts
+++ b/backend/src/index.ts
@@ -10,6 +10,7 @@ import fastifyStatic from "@fastify/static";
 import { resolve } from "path";
 import { existsSync, mkdirSync } from "fs";
 import { env } from "./plugins/env.js";
+import { migrationsReady } from "./db/client.js";
 import { healthRoutes } from "./routes/health.js";
 import { authRoutes } from "./routes/auth.js";
 import { medicationRoutes } from "./routes/medications.js";
@@ -17,6 +18,10 @@ import { settingsRoutes } from "./routes/settings.js";
 import { plannerRoutes } from "./routes/planner.js";
 import { startReminderScheduler } from "./services/reminder-scheduler.js";
 
+// Wait for database migrations before anything else
+await migrationsReady;
+console.log("[DB] Migrations complete, starting server...");
+
 // Ensure images directory exists
 const imagesDir = resolve(process.cwd(), "data/images");
 if (!existsSync(imagesDir)) {