Vasovagal syncope (VVS) can be classical (typical) or non-classical (atypical). Classical VVS is diagnosed when precipitating events, such as emotional or orthostatic triggers, are associated with typical autonomic prodromes.1 If triggers and/or prodromes are not present, VVS is defined as non-classical. The mechanisms of VVS have not been completely elucidated. Our knowledge of the afferent part of the vasovagal reflex (i.e. the step from trigger to autonomic control and central processing) is very limited. In contrast, the efferent part of the reflex is quite certain: hypotension and bradycardia are due to transient inhibition of the sympathetic system and to more or less marked activation of the vagal system, respectively. Treatments of VVS do not appear to be very effective, although some encouraging results have been published.2 Moreover, it is not always easy to understand how the positive results have been obtained, i.e. whether through prevention of the vasovagal reflex or through treatment of the impending reflex . In this regard, a ‘cocktail’ of recommendations and treatments is often prescribed which can act in accordance with both strategies. In medicine, prevention and therapy generally represent, at least from a conceptual point of view, two different approaches; however, with regard to the treatment of VVS, there is some confusion in the current literature. In order to investigate this aspect thoroughly, we should analyse the vasovagal reflex. VVS is often considered a characteristic of humans, since emotional or orthostatic loss of consciousness is not (or extremely rarely) observed in animals. Actually, the vasovagal reflex (hypotension and bradycardia) has been observed in humans and other mammals during hemorrhagic shock. The trigger of the vasovagal reflex appears to be the same during hemorrhagic shock and orthostatic stress (prolonged standing, tilt testing), i.e. thoracic hypovolaemia which activates the afferent pathways. Interestingly, the efferent part … *Corresponding author. Tel: +39 051 6838219; fax: +39 051 6838471, Email: p.alboni{at}ausl.fe.it