In recent times, due to the rapid infrastructure development worldwide, the use of concrete has greatly increased. However, concrete structures face various risks such as dynamic forces from winds or earthquakes and environmental impacts such as corrosion. These challenges are more significant because of the saturation of infrastructure projects worldwide. To tackle these issues and ensure the long-term strength of structures, the field of structural health monitoring (SHM) has gained significance. One of the most promising technologies for SHM is smart aggregates (SAs). These are special materials that are embedded in concrete and serve three main purposes: monitoring early-age concrete strength, detecting impacts of various factors, and continuously monitoring the health of structures. SAs have several advantages regarding SHM, including being able to detect a wide frequency range, quick response times, cost-effective, and easy to manufacture and process. Because of these benefits, they are becoming widely used for SHM. In recent years, there have been significant improvements in SA technology. This article provides a comprehensive overview of the use of SAs for SHM. It also discusses the advances in SAs in the last 20 years regarding three main areas: technology development, measurement range, and wireless capabilities. Additionally, this article briefly discusses recent real-world uses of SAs for SHM. Finally, this article outlines potential future trends in the development of SA technology. It emphasizes the need for more research to better understand how these materials perform and how effective they are in different situations. This research is crucial for further advancements in ensuring the durability and safety of structures.