Brown spot of rice, caused by Helminthosporium oryzae (syn. Bipolaris oryzae), continues to pose a serious threat to rice production, particularly in resource-limited and stress-prone agroecosystems. The disease reduces yield, seed quality, and market value of rice as it has historically contributed to major food security crises. This review synthesizes research published between 2008 and 2025, aiming to critically evaluate pathogen biology, epidemiology, and sustainable management strategies for rice brown spot. H. oryzae is a highly adaptable pathogen capable of infecting rice at all of its growth stages, surviving through infected seeds, crop residues, and airborne dispersal. Disease development is strongly influenced by environmental factors, particularly high relative humidity, prolonged leaf wetness, and moderate temperatures. A clear understanding of the pathogen’s life cycle and epidemiological drivers is essential for designing effective disease management strategies. Current management strategies include the use of resistant varieties, synthetic fungicides, botanical extracts, and biocontrol agents. Among chemical options, triazole-based fungicides such as propiconazole and tebuconazole have shown effective suppression of brown spot severity and yield improvement. However, concerns over fungicide resistance, environmental toxicity, and regulatory restrictions necessitate alternative approaches. Plant-derived extracts (e.g., neem, Acorus calamus, and chirata) have demonstrated moderate antifungal activity while offering environmental safety and biodegradability. Biological control agents, including Trichoderma viride, Pseudomonas fluorescens, and Pseudomonas aeruginosa, have shown broad-spectrum inhibition of H. oryzae through antibiosis, mycoparasitism, and induced systemic resistance. This review compares and contrasts the efficacy of these management options and emphasizes the integration of resistant cultivars, biocontrol agents, and botanicals into an Integrated Disease Management framework for its better management. Such an approach promises sustainable, cost-effective, and environmentally responsible brown spot control, especially under changing climatic conditions and increasing consumer demand for residue-free rice.