As the reliability and lifespan requirements of modern equipment continues to escalate, the problems with very high cycle fatigue (VHCF) has obtained increasingly widespread attention, becoming a hot topic in fatigue research. Titanium alloys, which are the most extensively used metal materials in the modern aerospace industry, are particularly prone to VHCF issues. The present study systematically reviewed and summarized the latest (since 2010) developments in VHCF research on titanium alloy, with special focus on the (i) experimental methods, (ii) macroscopic and microscopic characteristics of the fatigue fractures, and (iii) construction of fatigue fracture models. More specifically, the review addresses the technological approaches that were used, mechanisms of fatigue crack initiation, features of the S–N curves and Goodman diagrams, and impact of various factors (such as processing, temperature, and corrosion). In addition, it elucidates the damage mechanisms, evolution, and modeling of VHCF in titanium alloys, thereby improving the understanding of VHCF patterns in titanium alloys and highlighting the current challenges in VHCF research.