High cholesterol itself usually does not cause any symptoms, including headaches or dizziness. But elevated levels of cholesterol can indirectly produce symptoms, especially the so-called bad cholesterol known as low-density lipoprotein cholesterol (LDL-C). This occurs because high cholesterol increases your likelihood of developing atherosclerosis, a condition in which cholesterol and other materials accumulate to form plaques along the inside walls of arteries. Atherosclerosis of arteries either leading to or located within the brain can lead to a transient ischemic attack (TIA) or stroke, which may be accompanied by headaches and dizziness. Do not ignore these symptoms if you have been diagnosed with high cholesterol.
Hypercholesterolemia: A Mostly Silent Disease
A high blood cholesterol level, or hypercholesterolemia, generally causes no symptoms. The excess cholesterol sometimes accumulates in the eyes, eyelids, skin or tendons, but even these accumulations usually produce no symptoms. Deposits in the eye -- called arcus corneae -- appear as a whitish or grayish ring between the colored iris and the outer white part of the eye. Eyelid deposits called xanthelasma appear as yellowish lumps. Both types of deposits can develop when LDL-C levels remain high for a prolonged time, but they also occur in people with normal levels. Xanthomas, which are collections of cholesterol in the skin or tendons, are primarily found in people with severe, hereditary hypercholesterolemia. They appear as lumps in various places, such as behind the ankles, around the knees and elbows, and on the hands.
High Cholesterol as an Atherosclerosis Risk Factor
The major concern with high cholesterol is that it increases the risk of developing atherosclerosis. Atherosclerosis plaques narrow arteries, causing less blood and oxygen to be delivered to the areas supplied by these vessels. Small pieces of plaque can also break away, enter the blood and eventually block blood flow in smaller, downstream arteries. Depriving cells of blood and oxygen causes ischemia, which causes them to malfunction and eventually leads to cell death.
The effects of atherosclerosis depend on which arteries are involved. With cerebrovascular disease, atherosclerosis affects the arteries leading to the brain, such as the carotid arteries in the neck, or arteries within the brain. Cerebrovascular atherosclerosis can lead to various neurologic symptoms, depending on the specific brain area receiving an inadequate supply of blood and oxygen. These symptoms include arm, leg or facial weakness or numbness, difficulty speaking or impaired vision, among others. If the neurologic symptoms last less than 24 hours, the event is called a TIA. If symptoms persist beyond 24 hours, it is called a stroke or cerebrovascular accident.
Cerebrovascular Disease as a Possible Culprit
Headaches and dizziness are also possible symptoms of a TIA or stroke. According to a September 2015 article published in "The Journal of Headache and Pain," headaches occur in about one-quarter of people during a stroke. But this could be an underestimate as headaches may be overshadowed by more obvious neurologic symptoms. It is not entirely understood how a TIA or stroke due to atherosclerosis causes headaches, but leading theories include the release of chemicals from damaged brain tissue, or direct activation of pain sensors in the blood vessel walls because of blood flow changes.
Dizziness may occur with TIAs or strokes affecting areas of the brain controlling balance or blood pressure. Low blood pressure often leads to dizziness. In a study published in "Stroke" in October 2006, 3.2 percent of more than 1,600 adults seen in the emergency room with the main symptom of dizziness were found to have a stroke or TIA. Most individuals with a TIA or stroke had additional neurologic symptoms, and almost three-quarters had at least 2 risk factors for cerebrovascular disease, including hypercholesterolemia, high blood pressure and diabetes.
Medications and Other Diseases to Be Considered
Headaches and dizziness are possible side effects of many medications. Almost all drugs used to treat high cholesterol might sometimes cause headaches and dizziness. These include most statin drugs, such as simvastatin (Zocor) and lovastatin (Mevacor), bile acid sequestrants such as cholestyramine (Questran) and colestipol (Colestid), as well as ezetimibe (Zetia).
As headaches and dizziness are very common symptoms, their occurrence may be completely unrelated to cholesterol levels. Primary headache disorders, such as migraine headaches, can cause both symptoms. Upper respiratory tract infections or the flu may likewise cause both headaches and dizziness. Less commonly, these symptoms are due to low blood sugar, carbon monoxide poisoning, or an injury, infection, bleeding or tumor involving the brain. High blood pressure alone does not cause headaches and dizziness, but like hypercholesterolemia, it can indirectly lead to these symptoms by increasing the likelihood of developing cerebrovascular disease.
If you have high cholesterol and are experiencing episodes of headaches and dizziness, see your doctor to determine the cause. If these symptoms develop suddenly, seek immediate medical attention as they might signal a TIA or stroke. This is particularly likely if you have any other neurologic symptoms at the same time.
It is important to follow your doctor’s advice regarding ways to lower your cholesterol and reduce your likelihood of developing significant atherosclerosis. General recommendations for decreasing atherosclerosis risk include lifestyle changes, such as regular exercise, following a heart-healthy diet and eliminating or reducing other risk factors by stopping smoking, achieving a healthy weight and maintaining normal blood pressure, blood sugar and LDL-C levels. Treatment with medications, usually statin drugs, may also be recommended.
Reviewed by: Tina M. St. John, M.D.
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