If you happen to be using MSSQL or Postgres, the Redgate tools are a game changer for schema management. I was a big fan of using things like EF and custom code to handle schema migrations until I tried SQL Compare. These tools make normalizing a large number of instances significantly easier. If you've got a multi tenant setup where everything should have the same schema, you could fix the whole fleet in an afternoon.

For SQLite, I still vastly prefer using custom code to run migrations. Something about the ownership model makes manual external tooling feel inappropriate.