diff --git a/src/alpine_bits_python/run_migrations.py b/src/alpine_bits_python/run_migrations.py
index 3e1583e..89cbb03 100644
--- a/src/alpine_bits_python/run_migrations.py
+++ b/src/alpine_bits_python/run_migrations.py
@@ -5,6 +5,10 @@ This script should be run before starting the application to ensure
 the database schema is up to date. It can be run standalone or called
 from run_api.py before starting uvicorn.
 
+If the database is completely empty (no tables), it will create all tables
+from the current SQLAlchemy models and stamp the database with the latest
+migration version, avoiding the need to run historical migrations.
+
 Usage:
     uv run python -m alpine_bits_python.run_migrations
     or
@@ -12,24 +16,158 @@ Usage:
     run_migrations()
 """
 
+import asyncio
 import subprocess
 import sys
 from pathlib import Path
 
+from sqlalchemy import text
+from sqlalchemy.ext.asyncio import create_async_engine
+
+from .config_loader import load_config
+from .db import Base, get_database_schema, get_database_url
 from .logging_config import get_logger
 
 _LOGGER = get_logger(__name__)
 
 
+async def is_database_empty() -> bool:
+    """Check if the database has any tables in our schema.
+
+    Returns:
+        True if the database has no tables in the target schema, False otherwise.
+    """
+    try:
+        app_config = load_config()
+        db_url = get_database_url(app_config)
+        schema = get_database_schema(app_config)
+
+        if not db_url:
+            _LOGGER.error("Database URL not configured")
+            return False
+
+        # Create async engine for checking
+        engine = create_async_engine(db_url, echo=False)
+
+        async with engine.connect() as conn:
+            # Set search path if schema is configured
+            if schema:
+                await conn.execute(text(f"SET search_path TO {schema}"))
+
+            # Check for any tables in the schema
+            result = await conn.execute(
+                text(
+                    """
+                    SELECT COUNT(*)
+                    FROM information_schema.tables
+                    WHERE table_schema = :schema
+                    """
+                ),
+                {"schema": schema or "public"},
+            )
+            count = result.scalar()
+            await engine.dispose()
+            return count == 0
+
+    except Exception as e:
+        _LOGGER.warning(f"Could not check if database is empty: {e}")
+        return False
+
+
+async def create_all_tables() -> None:
+    """Create all tables from SQLAlchemy models in an empty database."""
+    try:
+        app_config = load_config()
+        db_url = get_database_url(app_config)
+        schema = get_database_schema(app_config)
+
+        if not db_url:
+            _LOGGER.error("Database URL not configured")
+            sys.exit(1)
+
+        _LOGGER.info("Creating all database tables from SQLAlchemy models...")
+
+        # Create async engine
+        engine = create_async_engine(db_url, echo=False)
+
+        async with engine.begin() as conn:
+            # Set search path if schema is configured
+            if schema:
+                await conn.execute(text(f"CREATE SCHEMA IF NOT EXISTS {schema}"))
+                await conn.execute(text(f"SET search_path TO {schema}"))
+
+            # Create all tables
+            await conn.run_sync(Base.metadata.create_all)
+
+        await engine.dispose()
+        _LOGGER.info("All tables created successfully")
+
+    except Exception as e:
+        _LOGGER.error(f"Failed to create tables: {e}")
+        sys.exit(1)
+
+
+def stamp_database() -> None:
+    """Stamp the database with the latest migration version.
+
+    This tells Alembic that the database is at the 'head' revision without
+    actually running the migration scripts.
+    """
+    _LOGGER.info("Stamping database with latest migration version...")
+
+    project_root = Path(__file__).parent.parent.parent
+
+    try:
+        result = subprocess.run(
+            ["alembic", "stamp", "head"],
+            cwd=project_root,
+            capture_output=True,
+            text=True,
+            check=True,
+        )
+
+        _LOGGER.info("Database stamped successfully")
+        _LOGGER.debug("Stamp output: %s", result.stdout)
+
+    except subprocess.CalledProcessError as e:
+        _LOGGER.error("Failed to stamp database:")
+        _LOGGER.error("Exit code: %d", e.returncode)
+        _LOGGER.error("stdout: %s", e.stdout)
+        _LOGGER.error("stderr: %s", e.stderr)
+        sys.exit(1)
+    except FileNotFoundError:
+        _LOGGER.error(
+            "Alembic not found. Please ensure it's installed: uv pip install alembic"
+        )
+        sys.exit(1)
+
+
 def run_migrations() -> None:
     """Run Alembic migrations to upgrade database to latest schema.
 
-    This function runs 'alembic upgrade head' to apply all pending migrations.
-    It will exit the process if migrations fail.
+    If the database is empty, creates all tables from SQLAlchemy models
+    and stamps the database with the latest migration version.
+
+    Otherwise, runs 'alembic upgrade head' to apply all pending migrations.
 
     Raises:
         SystemExit: If migrations fail
     """
+    _LOGGER.info("Checking database state...")
+
+    # Check if database is empty
+    is_empty = asyncio.run(is_database_empty())
+
+    if is_empty:
+        _LOGGER.info(
+            "Database is empty - creating all tables from models and stamping version"
+        )
+        asyncio.run(create_all_tables())
+        stamp_database()
+        _LOGGER.info("Database initialization completed successfully")
+        return
+
+    # Database has tables, run normal migrations
     _LOGGER.info("Running database migrations...")
 
     # Get the project root directory (where alembic.ini is located)