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In the existing building stock, typically characterised by a high degree of irregularity, the effects of earthquakes are strongly dependent on the epicentre–structure direction and the angle of incidence of the seismic motion. However, the scientific community has not yet reached a unanimous consensus on the evaluation of the effects of seismic incidence angles. Therefore, this paper conducts an extensive investigation of the international literature on current methods to consider seismic directionality, systematically reviewing more than 80 publications on this topic. Following a brief overview of the problem and an analysis of the initial developments of the multidirectionality concept of seismic input, a state-of-the-art review is presented based on the considered analysis methods, specifically response spectrum analysis, nonlinear static analysis, and nonlinear response history analysis. Moreover, the adoption of multidirectional seismic input in popular codes and standards is presented and discussed. This study provides the first comprehensive synthesis of research on the seismic incidence angles across diverse building typologies, offering crucial insights for future code revisions and highlighting significant gaps in current analytical methods and standards, thereby setting a new direction for subsequent empirical investigations. Specifically, the extensive state-of-the-art review revealed that, until now, the evaluation of the angle of incidence was primarily conducted on existing reinforced concrete buildings with a limited number of storeys, analysed with nonlinear response history analysis. This underscores the need for future research to extensively investigate the impact of the angle of incidence on other types of construction typologies.