The escalating global demand for sustainable energy has propelled the exploration of biohydrogen production with a promising avenue for simultaneously generating clean energy and managing waste effectively. This review mainly focuses on advances in sustainable biohydrogen production from saline wastewater, especially in a process that leverages the unique abilities of halotolerant and halophilic microorganisms adapted to high-salinity conditions. It provides an extensive understanding of various biohydrogen production methods, which are biophotolysis, photofermentation, dark fermentation, and microbial electrolysis. Additionally, this review elaborated on the enzymology of hydrogen production and the impact of salt stress, with a particular emphasis on the adaptive mechanisms of “salt-in” and “compatible solute” strategies. These adaptations are crucial for maintaining enzymatic activity and structural integrity under hypertonic conditions. Through a comprehensive examination of microbial pathways and strategies, this review aimed to furnish foundational insights that will drive future research and technological innovations in biohydrogen production.