It was created along with the South Caribbean Coast Autonomous Region by the Autonomy Statute of 7 September 1987 through a division of the former Zelaya Department.

It is the largest autonomous region or department in Nicaragua.

The North Autonomous Caribbean Coast has a Regional Council of representatives of different political parties, such as the Sandinistas (FSLN) and YATAMA (ethnic indigenous party), as well as all the municipalities.

The North Autonomous Caribbean Coast, in addition to Mestizos, contains populations from different indigenous groups, including the Miskitos, Mayangnas, and others.

The regional official languages are Creole (Miskito Coast Creole and Rama Cay Creole), Miskito, Sumo (Mayangna and Ulwa), Garifuna, and Rama, in addition to the national official language of Spanish,[3] most males in Puerto Cabezas speak some English from when it was a US fruit plantation.