Pilgrimage tourism remains one of the oldest and most significant forms of global mobility, drawing millions of tourists and devotees to sacred sites worldwide annually. While the rapid expansion of pilgrimage tourism generates substantial economic benefits, infrastructure development, and avenues for sustaining local cultures, it simultaneously introduces complex social, environmental, and infrastructural challenges to host communities. Consequently, local residents’ well-being has emerged as a paramount indicator for evaluating the true sustainability of pilgrimage tourism. The present extensive systematic review brings together the literature on the nexus between pilgrimage tourism and community well-being. It critically reviews the local community participation in tourism planning, residents’ perceptions about tourism development, multidimensional quality of life (QoL) outcomes, and sustainable destination management strategies. The review highlights the complex interaction of the components of community well-being, including economic prosperity, social cohesion, cultural preservation, and environmental sustainability. The study further highlights the critical need for inclusive governance, equitable benefit sharing and active community participation for sustainable tourism development. The study concludes with a comprehensive conceptual model to assess the impact of pilgrimage tourism on the well-being of local communities especially in the context of fast-growing pilgrimage destinations such as Haridwar and Rishikesh in India....