From the Guidelines

Paracetamol is the first-line treatment for cephalalgia in pregnancy.

Acute treatment: Paracetamol is the preferred medication for acute treatment of migraine in pregnancy due to its relatively safe profile 1.
NSAIDs: Can be used only during the second trimester, as their safety during the first and third trimesters is not well established 1.
Triptans: Should be used under strict supervision of a specialist, with sumatriptan being the most studied, but still having limited safety data 1.
Nausea treatment: Metoclopramide can be used to treat nausea associated with migraine in pregnancy 1.

Propranolol: Is the preferred preventive medication, with the best available safety data, but should be used under specialist supervision 1.
Amitriptyline: Can be used as an alternative to propranolol, if propranolol is contraindicated, also under specialist supervision 1.
Contraindicated medications: Topiramate, candesartan, and sodium valproate should be avoided due to their potential for fetal harm, with sodium valproate being teratogenic 1.

From the Research

Safe and effective medication and nonmedication treatment options are available for the pregnant headache sufferer, including both acute care and preventive therapies 2
Non-pharmacological interventions, such as relaxation, biofeedback, and lifestyle modification, are preferred therapeutic strategies for the treatment of primary headaches during pregnancy and breastfeeding 3
If non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks 3
Analgesics, such as acetaminophen and narcotics, can be used on a limited basis for the treatment of migraine in pregnancy 4
New therapies, such as calcitonin gene-related peptide monoclonal antibodies, lasmiditan, direct calcitonin gene-related peptide antagonists, and neuromodulation devices, are available for the treatment of headache in pregnancy and lactation 5

Proper diagnosis and treatment of headache disorders in pregnant and postpartum women are crucial to prevent complications and ensure the best possible outcomes for both mother and baby 6, 3
Red flags for secondary headache, such as elevated blood pressure and lack of a previous headache history, should be identified and investigated further 6
Diagnostic testing, such as electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography, and lumbar puncture, may be necessary to exclude secondary headache syndromes 3

Preconception planning and counseling are essential for patients of childbearing potential with headache to ensure safe care during pregnancy and lactation 2, 5
Modification of medication regimes to include medications safe for use during early pregnancy and effective nonmedication therapies should be considered before pregnancy 2