Earthquakes are known to affect groundwater properties, yet the mechanisms causing chemical and physical aquifer changes are still unclear. The Apennines mountain belt in Italy presents a rich literature of case studies documenting hydrogeochemical response to seismicity, due to the high frequency of seismic events and the presence of different regional aquifers in the area. In this study, we synthesize published data from the last 30 years in the Apennine region in order to shed light on the main mechanisms causing earthquake induced water changes. The results suggest the geologic and hydrologic setting specific to a given spring play an important role in spring response, as well as the timing of the observed response. In contrast to setting, the main focal mechanisms of earthquake and the distance between epicenter and the analyzed springs seems to present a minor role in defining the response. The analysis of different response variables, moreover, indicates that an important driver of change is the degassing of CO₂, especially in thermal springs, whereas a rapid increase in solute concentration due to permeability enhancement is observable in different cold and shallow springs. These findings also leave open the debate regarding whether earthquake precursors can be recognized beyond site-specific responses. Such responses can be understood more comprehensively through the establishment of a regional long-term monitoring system and continuous harmonization of data and sampling strategies, achievable in the Apennine region through the set-up of a monitoring network.