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Monte Carlo simulation of radiation transport is considered to be one of the most accurate methods of radiation therapy dose calculation. With the rapid development of computer technology, Monte Carlo based treatment planning for radiation therapy is becoming practical. A basic requirement for Monte Carlo treatment planning is a detailed knowledge of the radiation beams from medical accelerators. A practical approach to obtain the above is to perform Monte Carlo simulation of radiation transport in the medical accelerator. Additionally, Monte Carlo modelling of the treatment machine head can also improve our understanding of clinical beam characteristics, help accelerator design and improve the accuracy of clinical dosimetry by providing more realistic beam data. This paper summarizes work over the past two decades on Monte Carlo simulation of clinical electron beams from medical accelerators.