O’Neill’s first nine matches in charge of the national side had yielded five draws and four defeats, but his first taste of success at the highest level was a sweet one as his men got the better of former England boss Fabio Capello and his highly-rated charges in Belfast.
The tireless Paterson, only starting because of an injury to Kyle Lafferty, delivered the result by nodding home Niall McGinn’s 43rd-minute cross – his first competitive goal for Northern Ireland.
It was the least his energetic and passionate display deserved and he might have had another when his 58th minute header was chalked off to a tight offside flag.
The day had started inauspiciously for the hosts, with Manchester United defender Jonny Evans missing from the squad due to a stomach bug.
Craig Cathcart was drafted in at centre-half as a result, with Jamie Ward and Paterson given the attacking roles in place of Lafferty (Achilles) and Chris Brunt (suspended).
Northern Ireland started with intent as Ward, McGinn and Paterson all got shots away inside the first five minutes.
None caused Igor Akinfeev serious concern, but it at least showed belief.
Russia responded with a couple of early counter attacks - one falling to Aleksandr Kerzhakov in the area and the other seeing Alan Dzagoev line up a shot from 10 yards.
The breakthrough almost came in the 41st minute when Ward collected Danny Lafferty’s quick free-kick, carried the ball forward and then rifled a shot against the post from 25 yards.
Paterson tried to turn home the rebound but could not get any power on his touch.
Northern Ireland may have been frustrated but they responded in the ideal fashion.
McGinn was the provider, getting in behind his man and chasing the ball to the byline, where he hit a first-time cross towards Paterson.
The Huddersfield forward timed his leap and directed a fine header into the far corner.
With 58 minutes on the clock Northern Ireland – and Paterson – were agonisingly close to a second goal.
Shane Ferguson’s deep corner was steered back across goal by Cathcart and headed in by Paterson, only for a marginal offside flag to cut short the celebrations.
As the game entered the last 10 minutes, Roman Shirokov started to take the game to the hosts but his runs were not enough to unsettle a back line marshalled by Gareth McAuley.
Four tense minutes of injury-time prolonged O’Neill’s wait but Russia went limp as the time ebbed away.
Northern Ireland: Carroll, Lafferty, McAuley, Cathcart, Ferguson, Hughes McGinn (Evans 82), S Davis, Norwood, Paterson (Grigg 86), Ward.
Russia: Akinfeev, Aniukov, Ignashevich, Berezutsky, Denisov, Dzagoev (Cheryshev 45), Shirokov, Bystrov, Faitzulin, Kombarov, Kerzhakov (Dzjuba 46).
Referee: T Haggen.