Goreisan has long been prescribed for weather- and barometric pressure-related headache. However, its efficacy when initiated during the premonitory phase of migraine has not been systematically evaluated. We retrospectively reviewed 81 patients diagnosed with migraine (mean age: 41.7 ± 11.5 years; 14.8% male). Subtypes included migraine with aura (MA, n = 1), without aura (MO, n = 72), and combined type (MA + MO, n = 8). Patients who received Goreisan monotherapy during the premonitory phase were categorized as consistent responders (CRs) or inconsistent responders (IRs). Clinical characteristics and treatment responses were compared between the two groups. The overall response rate to Goreisan was 61.7% (n = 50). Headache profiles and the efficacy of triptans did not differ significantly between CRs and IRs. However, psychiatric comorbidities were more frequent in IRs than in CRs (p = 0.011). Initiating Goreisan during the premonitory phase appears to be an effective therapeutic approach for migraine patients with weather- and barometric pressure-related headache. Clinical background, including psychiatric history, may influence treatment outcomes and should be considered when selecting patients for this strategy.