The need to define and implement adaptation solutions has emerged since the early 1990s when the IPCC started assessing the changes, causes, potential impacts and responses to climate change. Yet, limited information exists on the context-specific effectiveness of local adaptation of agronomic practices. The Near East and North Africa (NENA) region is one of the world’s regions with the lowest per capita natural resources availability and one of the most vulnerable to climate change. For these reasons, there is an urgent need to improve the development and implementation of adaptation plans and actions to cope with climate change. This research implements the systematic review (SR) methodology to assess the scientific literature in adopting climate change adaptation practices for agriculture at the farm level in the NENA region. Results highlight a significant knowledge gap in adaptation in the region and recommend intensifying targeted research and funding to cope with urgent regional climate risks to rural and agricultural livelihoods. Key policy insights:A limited number of studies assess the costs and benefits of climate change adaptation options for the agricultural sector in the NENA region, with a majority of these published in the last ten years.Adapting crop management techniques to climate risks generates a net improvement in Near East and North Africa yields. However, adaptation responses aiming to increase agrosystems resilience show context-specific effectiveness.Water management options, which benefit crop water use efficiency to different extents, present relatively high implementation costs.Integrated management options show the potential to achieve additional multidimensional benefits. Still, well-designed long-term experiments are required to evaluate these practices in the different farming systems under present and projected climate conditions.An urgent need is to promote adaptation research for the various farming systems in the NENA region and to estimate the cost of adaptation measures to guarantee farmer incomes and food security in the face of climate change. A limited number of studies assess the costs and benefits of climate change adaptation options for the agricultural sector in the NENA region, with a majority of these published in the last ten years. Adapting crop management techniques to climate risks generates a net improvement in Near East and North Africa yields. However, adaptation responses aiming to increase agrosystems resilience show context-specific effectiveness. Water management options, which benefit crop water use efficiency to different extents, present relatively high implementation costs. Integrated management options show the potential to achieve additional multidimensional benefits. Still, well-designed long-term experiments are required to evaluate these practices in the different farming systems under present and projected climate conditions. An urgent need is to promote adaptation research for the various farming systems in the NENA region and to estimate the cost of adaptation measures to guarantee farmer incomes and food security in the face of climate change.