Recurrent episodes of unexplained syncope are among the most frequent of complaints referred to physicians for evaluation. Traditional methods of evaluation were both time consuming and expensive and left many patients without a diagnosis. Although neurocardiogenically mediated episodes of hypotension and bradycardia were felt to be a common cause of syncope, this was traditionally a diagnosis of exclusion. The emergence of head-upright tilt-table testing has provide a valuable method for identifying individuals predisposed to neurocardiogenic syncope and has also allowed for a better understanding of this phenomena. This article reviews the pathophysiology of neurocardiogenic syncope, the use of head-upright tilt-table testing in its diagnosis, and the potential therapies used to prevent recurrences.