The exposure of viticulture to climate change and extreme weather conditions makes the winemaking sector particularly vulnerable, being one of its major challenges in the current century. While grapevine is considered a highly tolerant crop to several abiotic stresses, Mediterranean areas are frequently affected by adverse environmental factors, namely water scarcity, heat and high irradiance, and are especially vulnerable to climate change. Due to the high socio-economic value of this sector in Europe, the study of adaptation strategies to mitigate the negative climate change impacts are of main importance for its sustainability and competitiveness. Adaptation strategies include all the set of actions and processes that can be performed in response to climate change. It is crucial to improve agronomic strategies to offset the loss of productivity and likely changes in production and fruit quality. It is important to look for new insights concerning response mechanisms to these stresses to advance with more effective and precise measures. These measures should be adjusted to local terroirs and regional climate change projections for the sustainable development of the winemaking sector. This review describes the direct climate change impacts (on phenology, physiology, yield and berry quality), risks, and uncertainties for Mediterranean viticulture, as well as a set of canopy, soil and water management practices that winegrowers can use to adapt their vines to warmer and drier conditions.