Sack Head is a passive item added to the Afterbirth DLC.
- Isaac wears a bag for a mask with holes for eyes and mouth.
- All hearts, bombs, keys, batteries, runes, and cards have a high chance of being replaced by a sack.
- All pickup have the chance of being replaced, they can be from chests, Shopkeepers, machines, etc.
- Contract From Below: Double the sacks earned from clearing rooms.
- D20: Because sacks often contain batteries, the D20 can reroll the contents into more batteries and more sacks. This could possibly lead to infinite pickups.
- Flat Penny: When a penny is picked up, a sack could spawn instead of a key. The sack could contain more pennies which could lead into, yep, more sacks.
- Head of the Keeper: Coins produced from hitting enemies could be replaced by sacks.
- Lucky Rock: Destroyed rocks have a high chance of dropping sacks instead of coins.
- Safety Scissors + Curse of the Tower: Each defused bomb have a chance of being replaced by a sack. Up to six sacks can spawn at once each time Curse of the Tower is triggered.
- Sack Head is a reference to sacks with Isaac's face worn by nude people as masks from the Rebirth trailer.