Head-up tilt table testing had been used as an investigative tool in the pathophysiology of orthostatic stress for more than 50 years,1 before the initial demonstration of its utility in the diagnosis of unexplained syncope.2 The Westminster group's landmark study found that 67% of patients with otherwise unexplained syncope demonstrated a vasovagal reaction during head-up tilt, compared to only 10% of healthy controls.2 Head-up tilt table testing has since evolved into the diagnostic test of choice in vasovagal syncope and related disorders, but there are still wide variations in the protocols used in various centres, hampering not only the clinical utility of the test but the adequate assessment of research activity in the field. The following protocols are based on the available evidence and our experience in this field and, as such, provide a practical and standardised approach. They are intended for use by cardiologists and other physicians with an interest in this topic, and hence assume some prior knowledge of the procedure. A more detailed description and justification for the protocols is readily available.3 ,4