diff --git a/bin/cli/sqlite.mjs b/bin/cli/sqlite.mjs
index 6b32c1a936..2bdb7bd544 100644
--- a/bin/cli/sqlite.mjs
+++ b/bin/cli/sqlite.mjs
@@ -5,15 +5,34 @@ import { ensureSettingsSchema, hashManagementPassword, updateSettings } from "./
 
 async function loadSqlite() {
   if (process.versions.bun) {
-    return (await import("bun:sqlite")).Database;
+    return { Database: (await import("bun:sqlite")).Database };
   }
   try {
-    return (await import("better-sqlite3")).default;
-  } catch {
-    throw new Error("better-sqlite3 is not installed. Run npm install before using setup.");
+    return { Database: (await import("better-sqlite3")).default };
+  } catch (error) {
+    return { error };
   }
 }
 
+// #7586: unlike the real server (src/lib/db/adapters/driverFactory.ts::tryOpenSync),
+// this CLI helper historically had NO fallback beyond better-sqlite3 — so on any
+// machine where better-sqlite3's native binary is unavailable (Windows without a
+// prebuilt addon, etc.), every `omniroute doctor` DB check reported a false FAIL
+// even when the actual server was healthy via its own (correct) driver cascade.
+// Reuse that same cascade here instead of re-deriving it.
+async function openWithSyncDriverFallback(dbPath, options, importError) {
+  try {
+    const { tryOpenSync } = await import("../../src/lib/db/adapters/driverFactory.ts");
+    const adapter = tryOpenSync(dbPath, options);
+    if (adapter) {
+      return adapter;
+    }
+  } catch {
+    // fall through to the original better-sqlite3 error below
+  }
+  throw createSqliteNativeError(importError);
+}
+
 function openBunSqlite(Database, dbPath, options) {
   const raw = new Database(dbPath, options);
   const prepare = (sql) => {
@@ -91,19 +110,25 @@ export function createSqliteNativeError(error) {
 }
 
 async function openSqliteDatabase(dbPath, options = {}) {
-  const Database = await loadSqlite();
+  const loaded = await loadSqlite();
   if (process.versions.bun) {
     if (options.fileMustExist && !fs.existsSync(dbPath)) {
       throw new Error(`SQLite file does not exist: ${dbPath}`);
     }
-    options = options.readonly
+    const bunOptions = options.readonly
       ? { readonly: true }
       : { readwrite: true, create: options.fileMustExist !== true };
+    try {
+      return openBunSqlite(loaded.Database, dbPath, bunOptions);
+    } catch (error) {
+      throw createSqliteNativeError(error);
+    }
+  }
+  if (loaded.error) {
+    return openWithSyncDriverFallback(dbPath, options, loaded.error);
   }
   try {
-    return process.versions.bun
-      ? openBunSqlite(Database, dbPath, options)
-      : new Database(dbPath, options);
+    return new loaded.Database(dbPath, options);
   } catch (error) {
     throw createSqliteNativeError(error);
   }
diff --git a/changelog.d/fixes/7586-windows-sqlite-launch.md b/changelog.d/fixes/7586-windows-sqlite-launch.md
new file mode 100644
index 0000000000..735f7b7556
--- /dev/null
+++ b/changelog.d/fixes/7586-windows-sqlite-launch.md
@@ -0,0 +1 @@
+- fix(cli): fall back to the node:sqlite driver cascade in `bin/cli/sqlite.mjs` so `omniroute doctor` no longer reports a false "FAIL Database"/"FAIL Storage/encryption" on machines without a working better-sqlite3 native binary (#7586)
diff --git a/tests/unit/cli-sqlite-no-fallback-7586.test.ts b/tests/unit/cli-sqlite-no-fallback-7586.test.ts
new file mode 100644
index 0000000000..67541973da
--- /dev/null
+++ b/tests/unit/cli-sqlite-no-fallback-7586.test.ts
@@ -0,0 +1,81 @@
+import { test } from "node:test";
+import assert from "node:assert/strict";
+import { register } from "node:module";
+import fs from "node:fs";
+import os from "node:os";
+import path from "node:path";
+import { DatabaseSync } from "node:sqlite";
+
+// #7586: `omniroute doctor`'s "Database" and "Storage/encryption" checks call
+// readDatabaseHealth()/readEncryptedCredentialSamples() from bin/cli/sqlite.mjs,
+// which — unlike the real server's driver cascade
+// (src/lib/db/adapters/driverFactory.ts::tryOpenSync, which tries
+// bun:sqlite -> better-sqlite3 -> node:sqlite) — used to have NO fallback beyond
+// better-sqlite3. On any machine where better-sqlite3's native binary is
+// unavailable (Windows without a prebuilt addon, per @jmaxdev's report), doctor
+// would ALWAYS report "FAIL Database" / "FAIL Storage/encryption" even when the
+// real server was perfectly healthy via its own resilient driver selection.
+//
+// This test simulates that exact machine by intercepting the ESM specifier
+// "better-sqlite3" (the one `bin/cli/sqlite.mjs::loadSqlite()` imports) so it
+// throws the same "Could not locate the bindings file" error jmax hit, then
+// proves readDatabaseHealth() still succeeds by falling back to node:sqlite.
+register(
+  "data:text/javascript," +
+    encodeURIComponent(`
+      export async function resolve(specifier, context, nextResolve) {
+        if (specifier === "better-sqlite3") {
+          return {
+            url:
+              "data:text/javascript," +
+              encodeURIComponent(
+                "throw new Error(" +
+                  JSON.stringify(
+                    "Could not locate the bindings file. Tried:\\n \\u2192 /fake/path/better_sqlite3.node"
+                  ) +
+                  ");"
+              ),
+            shortCircuit: true,
+          };
+        }
+        return nextResolve(specifier, context);
+      }
+    `),
+  import.meta.url
+);
+
+const { readDatabaseHealth } = await import("../../bin/cli/sqlite.mjs");
+
+test("#7586: readDatabaseHealth() falls back to node:sqlite when better-sqlite3 is unavailable", async (t) => {
+  const dbPath = path.join(os.tmpdir(), `cli-sqlite-no-fallback-7586-${Date.now()}.sqlite`);
+  t.after(() => {
+    try {
+      fs.unlinkSync(dbPath);
+    } catch {}
+  });
+
+  // Seed a normal, healthy DB using node:sqlite directly — simulating what the
+  // ACTUAL server (which DOES have a node:sqlite fallback) would have created
+  // on a machine without a better-sqlite3 native binary.
+  const seed = new DatabaseSync(dbPath);
+  seed.exec(
+    "CREATE TABLE _omniroute_migrations (version TEXT PRIMARY KEY, name TEXT NOT NULL, applied_at TEXT);" +
+      "INSERT INTO _omniroute_migrations (version, name, applied_at) VALUES ('001', 'initial_schema', datetime('now'));"
+  );
+  seed.close();
+
+  // Exercise the CLI helper's own health check — the exact function
+  // `omniroute doctor` calls (bin/cli/commands/doctor.mjs:checkDatabase ->
+  // readDatabaseHealth). Before the fix this threw "better-sqlite3 is not
+  // installed..." even though the DB is perfectly healthy.
+  const result = await readDatabaseHealth(dbPath);
+
+  assert.equal(
+    result.quickCheckValue,
+    "ok",
+    "readDatabaseHealth() should report a healthy DB via the node:sqlite fallback, " +
+      "not throw, when better-sqlite3 is unavailable (#7586)"
+  );
+  assert.equal(result.hasMigrationTable, true);
+  assert.deepEqual(result.appliedMigrationVersions, ["001"]);
+});