Why Do I Constantly Feel Off Balance?

Many people suffer from a balance disorder that makes them feel off balance, dizzy, or unsteady. A balance disorder is a condition in which one experiences a sensation of spinning, moving, or floating even if one is just lying down or standing still. It can happen anytime and anywhere. It may occur in episodes or may persist for extended periods. Sometimes it is associated with other symptoms, such as nausea, ringing in the ears, blurring of vision, or faintness. These symptoms can be quite alarming, so people might experience confusion, anxiety, and panic attacks as a result.

A balance disorder may be caused by a health condition or a problem involving the brain or inner ear, or some medications.

Typical Causes of Balance Disorder: Inner Ear, Brain, etc.

The body maintains balance with the combined efforts of different body systems, including the eyes, inner ears, proprioceptive receptors, and the brain. Any condition that affects one or more of these may cause a balance disorder or the feeling of being off balance.

Causes Related to the Ear

Vertigo, or a feeling of spinning, may be brought about by disturbances to the inner ear. This part of the balance system informs the brain about changes in your head's movements related to gravity. When this system is affected, vertigo, dizziness, nausea, and vomiting may be experienced.

Causes of vertigo related to the inner ear include:

  • Benign Paroxysmal Positional Vertigo (BPPV) is due to the detachment of small particles that are located in the inner ear, inhibiting normal functioning. Dizziness and spinning sensations may be intense and can occur suddenly when you move your head or roll out of bed. This may come and go and can recur for many years without treatment.
  • Inner ear infection or labyrinthitis may be caused by a virus or bacterial infection that leads to inflammation. This causes vertigo, ringing in the ear (tinnitus), nausea, vomiting, and hearing loss. People with this condition often experience anxiety and panic attacks. Treatment may include medications like prochloperazine and vestibular rehabilitation therapy (VRT).
  • Meniere's disease is a condition in which you experiences vertigo, nausea and vomiting, unilateral or bilateral hearing loss, tinnitus, and hearing loss. Some experience jerky eye movements (nystagmus) and others have a drop attack, in which they suddenly fall down. These symptoms usually occur consecutively and vertigo may last for many hours. To relieve symptoms, you must consume a diet that is low in salt and avoid smoking and alcohol ingestion.
  • Perilymph fistula involves the leakage of fluid from the inner ear to the middle ear, which may be caused by trauma, changes in ear pressure, chronic ear infection, ear surgery, or physical exertion. Besides dizziness, a person may experience unsteadiness while standing or walking, which is worsened by physical activity and improved with rest.

Causes Related to the Brain

Conditions in the brain may also be attributed to feeling off balance and vertigo:

  • Age-related or degenerative change in balance function is one of the most common causes of balance disorders characterized by vertigo. However, this may be due to other causes related to aging such as arteriosclerosis, which is the hardening and narrowing of the arteries that supply blood to the brain. A stroke, which is due to the disturbance of blood flow to the brain, may also cause dizziness and loss of balance. These degenerative changes may be associated with weakness and difficulty in standing and walking.
  • Trauma to the head is another possible cause of dizziness and loss of inner ear function. Depending on the site of trauma, the person may experience headaches, ringing in the ear, nausea, and vomiting. Medical consultation is required to diagnose and treat possible skull fracture and concussion.
  • Infections involving the brain such as meningitis, encephalitis, and brain abscess can cause dizziness and balance problems. These can also cause fever, nausea, vomiting, nystagmus, and blurred vision.
  • Meningitis involves inflammation of the covering of the brain and may cause neck stiffness and inability to tolerate light or loud noises. With encephalitis, there is inflammation of the brain that can also lead to convulsions or seizures, tremors, and hallucinations. A brain abscess may result from infections in the ear, sinuses, or other parts of the body. Aside from dizziness, nausea, and vomiting, you may experience headache, confusion, drowsiness, seizures, and weakness. Medical consultation is required to diagnose and treat the problem.
  • Migraines can cause vertigo and are known as vestibular migraine or migrainous vertigo. Symptoms include episodes of vertigo, typical migraine headaches, inability to tolerate light or sound, and experiencing visual or non-visual auras. Auras are perception of strange light, smell, or sensations that precede migraines.
  • Motion sickness occurs when one travels in a vehicle (car/boat/plane) and feels sick, dizzy, and nauseous. It may be relieved by taking a medication like Dramamine and by looking out of the window while traveling.

Other Causes

Other conditions like low blood pressure, diabetes, and intake of various medications can cause the feeling of being off balance.

  • Low blood pressure can often occur with common symptoms such as light-headedness and unsteadiness. A decrease in blood pressure may result in lack of blood flow to the brain. It may occur due to bleeding, thyroid problems, infections, or allergies. Medical attention is often necessary to diagnose the specific cause before treatment is given. Proper diet, lifestyle changes, and medications can help normalize blood pressure levels.
  • Diabetic neuropathy or nerve damage related to diabetes occurs due to chronic increases in blood sugar levels. Symptoms include low blood pressure, loss of balance upon sudden standing, and dizziness. Diagnosis depends on blood sugar levels and clinical evaluation. Treatment aims at decreasing blood glucose levels, taking proper diet, diabetes medications, regular exercise, and blood sugar monitoring.
  • Medications such as those used for high blood pressure, sedatives, and antihistamines can cause side effects such as dizziness and loss of balance. Sometimes this is be associated with drowsiness, nausea, and vomiting. These can therefore not be used if planning to travel or operate machinery.


There are many possible causes of balance disorders. If you think that it is a minor episode, such as motion sickness, you may try one of the remedies suggested, such as avoiding travel or sitting next to a window. Otherwise you may need to go to a doctor to have a proper evaluation, diagnosis, and treatment. For example, if the cause of vertigo and accompanying symptoms is an infection, then you may need a prescription for antibiotics.

In most cases of a balance disorder that is related to inner ear problems, vestibular rehabilitation exercises are used to treat the associated symptoms. These are simple exercises that combine head, eye, and body exercises to decrease dizziness and nausea. A therapist can even help you perform these at home.

To prevent injuries from dizziness, do not walk in the dark, wear low heels or walking shoes, use a cane, or if necessary, a walker. Ask your doctor if it is safe for you to drive.