The effect of elevation on insect herbivory has been a central topic in ecological research for decades. A key question is how insect herbivory varies along elevational gradients and the mechanisms driving these patterns. Recent meta-analyses have examined the relationship of elevation and insect herbivory globally and for tropical, polar and temperate climate zones. However, there is a lack of meta-analysis research focused on smaller-scale climate zones. Mediterranean-type climate (MTC) ecosystems are of particular importance since they constitute biodiversity hotspots and are threatened by anthropogenic forces including climate change which is having a disproportionate effect on these regions. Thus, understanding patterns of insect damage in these systems is important to both basic and applied science. We conducted a meta-analysis to assess the overall relationship of altitude and insect herbivore damage in MTC ecosystems considering the moderators damage type (leaf, seed, and borer); plant habit (woody and non-woody); elevation range (small vs. large); sampling period (< 2010 and 2010 ̵̶ 2025); taxonomic order (Fagales and non-Fagales), and leaf longevity (deciduous, semi-deciduous, evergreen). For overall herbivory and all but one moderator, we found no significant effects of elevation on insect damage in MTC ecosystems. For the 2010 ̵̶ 2025 sampling period moderator, we found a positive relationship of insect herbivory and altitude. A posteriori analyses with the 2010 ̵̶ 2025 sampling period group indicated positive relationships of elevation and herbivory in terms of leaf and seed damage; woody plants; and small elevation range. We point to climate change and the particularly hot and dry conditions in MTC ecosystems to explain results for recent sampling period. Abiotic conditions may be limiting to insects at lower elevations resulting in a range shift to higher elevations. Further research is necessary to validate these findings and to elucidate the underlying mechanisms.