Balance disturbance has many causes. Common ones include benign paroxysmal positional vertigo (due to loose matter moving around in the inner fluids), migraine (with or without headache) and, more rarely, Meniere's syndrome (always accompanied by unilateral hearing symptoms), vestibular neuronitis (never with hearing symptoms) and, rarely, more sinister causes related to brain dysfunction. A good history and thorough examination will usually allow a diagnosis and management plan to be decided upon. Rarely, complex assessments are required to come to a diagnosis.