Abstract: Hydrogels have hydrophilic three-dimensional network structure, which are widely used in biomedicine and other fields because of its similar structure and function to biological tissue. Silk fibroin (SF) has become one of potential hydrogel substrates due to its abundant resources, good biodegradability and biocompatibility. However, due to the dissolution and destruction of the natural hierarchical structure of silk fibers in the process of preparing silk fibroin, the natural advantage of high mechanical strength of silk fibers is lost, and the poor mechanical properties become one of the main reasons limiting the wide application of silk fibroin-based hydrogels. Therefore, researchers are constantly seeking strategies to prepare silk fibroin-based high strength hydrogels (SF-HSHs). This review first introduced the basic structure of SF. Then the preparation methods and gelation mechanisms of SF hydrogel were described. Furthermore, physical cross-linking, dual cross-linking, dual network and composite SF-HSHs were discussed in detail. Finally, the biological applications, prospects and challenges of SF-HSHs were briefly analyzed.