Performance-based accountability (PBA) has gained popularity worldwide due to its promise to strengthen the effectiveness and equity of educational systems. Nonetheless, its implementation does not always generate the expected reactions within schools. Through a configurative review, we systematically reviewed 133 empirical studies focusing on PBA side effects. We provide novel insights into the literature on PBA side effects, generating a better understanding of how and under what circumstances they are more likely to occur and through which mechanisms. In contrast to existing reviews, our research includes country contexts where accountability designs are predominantly low-stakes and challenges dichotomous ways of thinking about PBA systems. It uncovers side effects across diverse accountability frameworks and investigates differences and similarities in the mechanisms driving them.