This icon was highly venerated because it was believed that St Luke had painted it.   A lost document apparently recorded that the Emperor Frederick I gave it to Spoleto after the peace of 1185, and it was housed in the Duomo. 

(The earliest surviving documentation of its presence in the Duomo dates to 1291.  A new chapel, the "sacrastia nove della cona" (later the Cappella delle Reliquie), was built to provided a fitting location for it in 1540.  It was displayed in the tabernacle there until 1668, when Bishop Cesare Facchinetti translated it to another new chapel, the Cappella della SS Icone.  He also commissioned the present reliquary (1674) to replace an earlier one that is now lost.  A sketch of the lost reliquary in the Biblioteca Vallicelliana, Rome records that it had been commissioned in 1396.

The icon is mostly covered by its reliquary.  However, it was temporarily removed for examination in 1956.  This revealed that an inscription MP  OY identifies the half-length Virgin as the Mother of God, and that she holds a scroll that contains the Greek text of a dialogue in which she pleads with Christ for the redemption of mankind.  Another inscription identifies Irene Petraliphina as the person who had commissioned the icon.  She was a descendant of Peter Aliphas, a soldier from Alifa in Campania who entered the service of the Byzantine Emperor Alexius I Comnenus in 1085.   The icon was probably painted in Constantinople at about that time and it was almost certainly paired originally with another of Christ Antiphonites (Christ who answers).  Scientific analysis has shown that it has been damaged by fire and (possibly as a result) has been cut down in size.

The icon has long been at the centre of the celebration of Spoleto's most important religious holiday, the Feast of the Assumption (15th August).   Examples of the its  continued importance in relatively recent times include the following:

1. ✴When Pope Pius VII was en route to Rome from Venice in the difficult circumstances of 1800, he stopped at Spoleto to venerate the icon.
   

2. ✴It was taken in procession in 1856 at the end of an epidemic of cholera.  Among those that had died in the epidemic was the sister of the man who was later canonised as St Gabriel Possenti.  He was moved to take religious vows during this procession.
   

3. ✴In the Jubilee year (2000) it was taken in procession throughout the diocese over a period of ten days.
   

The icon features in a series of processions each August, culminating in a solemn procession from San Gregorio Maggiore to the Duomo on 14th August.  It is then displayed from the portico of the Duomo on the following day, the Feast of the Assumption.