Syncope is a common problem in medical practice. Of the various types of syncope, the neurally mediated syncopal syndromes (of which vasovagal syncope is the most common) predominate. In most cases, neurally mediated syncope is a solitary event that can be managed with only reassurance, but certain patients (those with multiple recurrences or those who have been injured as a result of syncope) need further investigation and therapy. Dietary and lifestyle changes are crucial and often overlooked aspects of therapy that may be sufficient to control symptoms. Pharmacologic therapy, which usually starts with beta-blockers or fludrocortisone, can also be effective. Finally, certain patients may continue to have recurrences despite the use of both nonpharmacologic and pharmacologic therapy. It was recently demonstrated that permanent pacing may be effective in preventing recurrent syncopal episodes in some of these patients.