Occipital neuralgia (ON) is characterized by attacks of lancinating, shock-like, paroxysmal pain radiating from the occiput to the posterior scalp in the greater and lesser occipital nerve distributions. Occipital nerve stimulation (ONS) is a potentially safe and reversible therapy for medically refractory ON. Since there are no prospective randomized studies studying ONS efficacy, a multidisciplinary task force performed a systematic literature review to address this question. Class III evidence from all 9 primary articles located support the conclusion of Level 3 evidence for ONS as an effective treatment for medically refractory ON. Technical specifications in lead positioning, lead configuration, type of sedation, or the predictive use of occipital nerve blocks prior to ONS were not supported. Prospective, randomized studies utilizing subthreshold stimulation are needed to determine the long-term utility of ONS for ON and to address secondary anatomical and technical considerations.