Editing Reflex syncope (section)

==Treatment==
Treatment for reflex syncope focuses on avoidance of triggers, restoring blood flow to the brain during an impending episode, and measures that interrupt or prevent the [[#Pathophysiology and mechanism|pathophysiologic mechanism]] described above.{{citation needed|date=April 2021}}

===Lifestyle changes===
* The cornerstone of treatment is avoidance of triggers known to cause syncope in that person. However, research has shown that people show great reductions in vasovagal syncope through exposure-based exercises with therapists if the trigger is mental or emotional, e.g., sight of blood.<ref name="Durand, VM 2006. pp. 150">{{Cite book |author1=Durand, VM |author2=DH Barlow |year=2006 |title=Essentials of Abnormal Psychology 4th Edition |page=150 |publisher=Cengage Learning |url=https://books.google.com/books?id=OCaeCAAAQBAJ&q=Durand,+VM,+and+DH+Barlow.+2006.+Essentials+of+Abnormal+Psychology+4th+Edition&pg=PT6 |access-date=12 August 2016|isbn=978-1111836986 }}</ref> However, if the trigger is a specific drug, then avoidance is the only treatment.
* A technique known as "applied tension" may be additionally useful in those who have syncope with exposure to blood.<ref>{{cite book |last1=Hersen |first1=Michel |title=Encyclopedia of Behavior Modification and Cognitive Behavior Therapy |date=2005 |publisher=SAGE |isbn=9780761927471 |page=30 |url=https://books.google.com/books?id=LF05DQAAQBAJ&pg=PT50 }}</ref> The technique is done by tightening the skeletal muscles for about 15 seconds when the exposure occurs and then slowly releasing them.<ref name=Fel2006/> This is then repeated every 30 seconds for a few minutes.<ref name=Fel2006>{{cite book |last1=Felgoise |first1=Stephanie |last2=Nezu |first2=Arthur M. |last3=Nezu |first3=Christine M. |last4=Reinecke |first4=Mark A. |title=Encyclopedia of Cognitive Behavior Therapy |date=2006 |publisher=Springer Science & Business Media |isbn=9780306485817 |page=291 |url=https://books.google.com/books?id=bQ1KAAAAQBAJ&pg=PA291 }}</ref>
* Because vasovagal syncope causes a decrease in blood pressure, relaxing the entire body as a mode of avoidance is not favorable.<ref name="Durand, VM 2006. pp. 150"/> A person can move or cross their legs and tighten leg muscles to keep blood pressure from dropping so significantly before an injection.<ref name="pmid16398666">{{cite journal |vauthors=France CR, France JL, Patterson SM |title=Blood pressure and cerebral oxygenation responses to skeletal muscle tension: a comparison of two physical maneuvers to prevent vasovagal reactions |journal=Clinical Physiology and Functional Imaging |volume=26 |issue=1 |pages=21–5 |date=January 2006 |pmid=16398666 |doi = 10.1111/j.1475-097X.2005.00642.x |s2cid=2763372 }}</ref>
* Before known triggering events, the affected person may increase consumption of salt and fluids to increase blood volume. Sports drinks or drinks with electrolytes may be helpful.
* People should be educated on how to respond to further episodes of syncope, especially if they experience [[prodrome|prodromal]] warning signs: they should lie down and raise their legs, or at least lower their head to increase blood flow to the brain. At the very least, upon the onset of initial symptoms the patient should try to relocate to a 'safe', perhaps cushioned, location in case of losing consciousness. Positioning themselves in a way where the impact from falling or collapsing would be minimized is ideal. The 'safe' area should be within close proximity, since, time is of the essence and these symptoms usually climax to loss of consciousness within a matter of minutes. If the individual has lost consciousness, he or she should be laid down in the [[recovery position]]. Tight clothing should be loosened. If the inciting factor is known, it should be removed if possible (for instance, the cause of pain).
* Wearing graded compression stockings may be helpful. Moreover, assuming a sedentary position and raising the legs above the height of head.

===Medications===
* Certain [[medications]] may  also be helpful:
** [[Beta blocker]]s (β-adrenergic antagonists) were once the most common medication given; however, they have been shown to be ineffective in a variety of studies and are thus no longer prescribed. In addition, they may cause the syncope by lowering the blood pressure and heart rate.<ref name="pmid16505178">{{cite journal |vauthors=Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C, Talajic M, Ku T, Fouad-Tarazi F, Ritchie D, Koshman ML | title = Prevention of Syncope (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope | journal = Circulation | volume = 113 | issue = 9 | pages = 1164–70 | date = March 2006 | pmid = 16505178 | doi = 10.1161/CIRCULATIONAHA.105.535161 | doi-access =  | s2cid = 12778841 }}</ref><ref name="pmid11216978">{{cite journal |vauthors=Madrid AH, Ortega J, Rebollo JG, Manzano JG, Segovia JG, Sánchez A, Peña G, Moro C | title = Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebo-controlled study | journal = J. Am. Coll. Cardiol. | volume = 37 | issue = 2 | pages = 554–9 | date = February 2001 | pmid = 11216978 | doi = 10.1016/S0735-1097(00)01155-4 | doi-access = free }}</ref>
** Medications which may be effective include: CNS stimulants<ref>{{cite journal|title= The use of methylphenidate in the treatment of refractory neurocardiogenic syncope|date=2012-05-24 |pmid=8734752 | volume=19|issue=5 |journal=Pacing Clin Electrophysiol|pages=836–40|vauthors=Grubb BP, Kosinski D, Mouhaffel A, Pothoulakis A |doi=10.1111/j.1540-8159.1996.tb03367.x |s2cid=34197462 }}</ref> [[fludrocortisone]], [[midodrine]], [[SSRI]]s<ref>{{cite journal|last1=Ali Aydin|first1=Muhammet|last2=Salukhe|first2=Tushar|last3=Wilkie|first3=Iris|last4=Willems|first4=Stephan|title=Management and therapy of vasovagal syncope: A review|journal=World J Cardiol|pmc=2998831|pmid=21160608|doi=10.4330/wjc.v2.i10.308|volume=2|issue=10|year=2010|pages=308–15 |doi-access=free }}</ref> such as [[paroxetine]] or [[sertraline]], [[disopyramide]], and, in health-care settings where a syncope is anticipated, [[atropine]] or epinephrine (adrenaline).<ref>{{Cite journal |url=http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/Nursing%20Drug%20Guide/mg/epinephrine.htm |title=epinephrine (adrenaline) |author=Amy M. Karch |journal=2006 Lippincott's Nursing Drug Guide |access-date=12 August 2016 |archive-date=29 June 2017 |archive-url=https://web.archive.org/web/20170629215823/http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/Nursing%20Drug%20Guide/mg/epinephrine.htm |url-status=dead }}</ref>
* For people with the cardioinhibitory form of vasovagal syncope, implantation of a [[artificial pacemaker|permanent pacemaker]] may be beneficial or even curative.<ref>{{cite web |title=Vasovagal Syncope: What is it? |url=http://www.vasovagal-syncope.com/ |url-status=dead |archive-url=https://web.archive.org/web/20140103161954/http://vasovagal-syncope.com/ |archive-date=3 January 2014 |access-date=11 August 2016}}</ref>
Types of long-term therapy for vasovagal syncope include<ref name="Fenton, A. M. 2000"/>
* Preload agents
* Vasoconstrictors
* Anticholinergic agents
* Negative cardiac inotropes
* Central agents
* Mechanical device
* Discontinuation of medications known to lower blood pressure may be helpful, but stopping [[antihypertensive drugs]] can also be dangerous in some people. Taking antihypertensive drugs may worsen the syncope, as the hypertension may have been the body's way to compensate for the low blood pressure.