From the Guidelines

Paracetamol is the safest treatment option for headaches during pregnancy.

Paracetamol is the preferred first-line medication for acute treatment of headaches in pregnancy, due to its relatively poor efficacy but safe profile 1.
NSAIDs, such as ibuprofen, can be used only during the second trimester 1.
Metoclopramide can be used for nausea associated with migraine in pregnancy 1.

Propranolol and amitriptyline are the best available options for preventive migraine medications during pregnancy, but should be used under specialist supervision 1.
Topiramate, candesartan, and sodium valproate are contraindicated due to potential fetal harm 1.

Migraine often remits during pregnancy, but if treatment is continued, the potential for harm to the fetus demands special consideration 1.
A clear risk-benefit assessment regarding the necessity of headache treatment during pregnancy should be discussed with the patient 1.
Acetaminophen is widely used during pregnancy, with 40-65% of pregnant women using it at some time during their pregnancy, mostly for headache and fever 1.

From the Research

Non-pharmacologic treatments, such as relaxation, biofeedback, and lifestyle modification, are ideal solutions for managing headaches during pregnancy 2, 3, 4
Acetaminophen (paracetamol) is considered a safe and effective treatment option for acute migraine attacks during pregnancy, with a recommended dose of 1000 mg, preferably as a suppository 4
Aspirin and ibuprofen may be used episodically during pregnancy, but should be avoided during the last trimester due to potential risks 4
Metoclopramide and prochlorperazine may be used to treat nausea during pregnancy, with metoclopramide being acceptable for use during the second and third trimesters 4, 5
Combination metoclopramide and diphenhydramine may be more effective than codeine for treating migraine or tension headache during pregnancy 5
Triptans, such as sumatriptan, zolmitriptan, and naratriptan, are contraindicated in pregnancy, while low-dose aspirin may not be associated with fetal/child adverse effects 4, 5
Calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects and may be used for prevention of primary headache during pregnancy 5

Diagnostic testing should be used to exclude organic causes of headache and establish a baseline before treatment 2
Medication use should be limited during pregnancy, but is not absolutely contraindicated 2
Clinicians should recognize the importance of treating headache during pregnancy to limit excessive use of over-the-counter pain remedies, dehydration, and pain-related disability 3
Preconception planning should include modification of medication regimes to include medications safe for use during early pregnancy 3