Alembic migrations help update your database schema step-by-step. First, you create a migration script using 'alembic revision -m' with a message describing the change. This script is empty initially, so you edit it to add the specific schema changes like creating tables or adding columns. Then, you apply these changes to the database by running 'alembic upgrade head'. This updates the database schema. You can check which migrations have been applied with 'alembic history'. If needed, you can undo the last migration using 'alembic downgrade -1'. This process allows you to safely and clearly manage database changes over time.