A real-valued sequence f = {f(n)}_{n ∈ ℕ} is said to be second-order holonomic if it satisfies a linear recurrence f (n + 2) = P (n) f (n + 1) + Q (n) f (n) for all sufficiently large n, where P, Q ∈ ℝ(x) are rational functions. We study the ultimate sign of such a sequence, i.e., the repeated pattern that the signs of f (n) follow for sufficiently large n. For each P, Q we determine all ultimate signs that f can have, and show how they partition the space of initial values of f. This completes the prior work by Neumann, Ouaknine and Worrell, who have settled some restricted cases. As a corollary, it follows that when P, Q have rational coefficients, f either has an ultimate sign of length 1, 2, 3, 4, 6, 8 or 12, or never falls into a repeated sign pattern. We also give a partial algorithm that finds the ultimate sign of f (or tells that there is none) in almost all cases.