Intracerebral hemorrhage (ICH), caused by the rupture of small blood vessels, remains the least treatable subtype of stroke. The pathophysiology of ICH involves immediate mechanical compression from the hematoma, followed by secondary injuries such as cerebral edema, inflammation, and neuronal damage. Management aims to prevent hematoma expansion, enable safe and effective hematoma evacuation, and mitigate secondary injuries. Recent advancements in clinical management, including blood pressure control, hemostatic therapy, surgical and minimally invasive hematoma removal, and complication management, offer new hope. This review synthesizes these advancements, integrating insights from recent research and clinical trials, and highlights significant progress in evidence-based approaches that pave the way for precise and personalized treatment strategies. Nonetheless, further research is necessary to enhance our understanding of ICH mechanisms and develop more effective clinical interventions.