Background: Occipital nerve stimulation (ONS) is a promising therapy for craniofacial pain syndromes refractory to conventional treatments. This study evaluates the long-term efficacy and safety of ONS over a 15-year period at Hôpital Enfant-Jésus, CHU de Québec, based on patient-reported outcomes and complication rates. Methods: A retrospective cohort analysis was conducted on patients with occipital neuralgia, cluster headaches, migraines, and other craniofacial pain syndromes who underwent ONS implantation. Pain intensity, quality of life, and patient-reported improvements were assessed at baseline, one year, and the latest follow-up. Trial stimulation was performed before permanent implantation. Results: Among 45 patients (mean age: 53.7 years), diagnoses included occipital neuralgia, migraines, cluster headaches, cervicogenic pain, and other pain syndromes. At follow-up (mean: 4.72 ± 1.02 years), NPRS scores decreased by 3.8 ± 1.7 points, BPI showed a 45% ± 18% reduction, and SF-36 revealed improvements in physical (20% ± 25%) and social functioning (30% ± 22%). Adverse events occurred in 27% of patients, with surgical revisions required in 14%. Conclusions: ONS provides significant, long-term pain relief and quality-of-life improvements in refractory craniofacial pain, particularly for occipital neuralgia and cluster headaches. While complications remain notable, advancements in techniques and technology may improve outcomes, supporting ONS in tailored pain management protocols.