This paper provides a synthesis and comparison of methodologies and results obtained in several studies devoted to the impact of climate change on hydropower. By putting into perspective various case studies, we provide a broader context and improved understanding of climate changes on energy production. We also underline the strengths and weaknesses of the approaches used as far as technical, physical and economical aspects are concerned. Although the catchments under investigation are located close to each other in geographic terms (Swiss and Italian Alps), they represent a wide variety of situations which may be affected by differing evolutions for instance in terms of annual runoff. In this study, we also differentiate between run-of-river, storage and pumping-storage power plants. By integrating and comparing various analyses carried out in the framework of the EU-FP7 ACQWA project, this paper discusses the complexity as well as current and future issues of hydropower management in the entire Alpine region.