Both Missing Page items explained: the trinket and Missing Page 2 (80 damage near-death trigger), trigger rates, how to get them, and Mysterious Paper.
Missing Page Isaac — The Trinket and the Item Explained
Isaac has two "Missing Page" items: the trinket A Missing Page (a chance to trigger a screen-wide 40-damage Necronomicon effect when hit) and the item Missing Page 2 (triggers screen-wide damage near death and buffs black heart explosions). If you searched "missing page isaac," you want both effects, their trigger conditions, and whether they're worth taking — plus how they relate to the Mysterious Paper trinket. All covered here.
Official resources: Steam store page · IGN game page · Official wiki A Missing Page page · Official wiki Missing Page 2 page
A Missing Page (Trinket): Screen-Wide Damage on Hit
Effect: when you take damage, a chance to deal 40 damage to every enemy in the room (the Necronomicon effect).
- Trigger chance scales with Luck: 50% trigger at +50 Luck (base around 2%)
- At high Luck it's basically "every hit is a screen-clearing counterattack"
- Look: a glowing red torn page, part of the "paper family" with the Missing Poster and Mysterious Paper
Missing Page 2 (Item): Near-Death Counter + Black Heart Buff
Effect (Quality 0 passive):
- +1 black heart on pickup
- When your total health drops to 1 heart after taking damage, automatically deals 40 screen-wide damage (Necronomicon)
- Doubles black heart explosion and Necronomicon damage to 80
- A Missing Page: probabilistic counter-damage, scales with Luck, shines in high-hit scenarios
- Missing Page 2: near-death insurance, one reliable screen-wide 80 proc plus the black heart buff — a "death guarantee" for squishy characters
The Relationship With Mysterious Paper
Mysterious Paper is a "random paper-family effect" trinket that can mimic: A Missing Page (screen damage on hit), Polaroid/Negative (low-HP shields), the Missing Poster (The Lost unlock puzzle). If you want the reliable Missing Page effect, take the real item — don't gamble on Mysterious Paper's random roll.
How to Get Them
| Item | Pool |
|---|---|
| A Missing Page | Normal trinket pool (drops directly, no unlock) |
| Missing Page 2 | Devil Room, Demon Beggar, Secret Room |
Missing Page 2's near-death proc only fires at 1 heart — it protects against "one hit from death," not "full HP rampage." Its real value is the black heart buff (+80 explosions): take it to play around black hearts, not as a clutch save.
Build Ideas
- High-Luck counter build: A Missing Page + high Luck (Perfection trinket, Luck pills) + Gimpy = hearts from hits + screen clears from hits
- Black heart explosion build: Missing Page 2 + black heart sources (Abaddon, Black Heart drops) = every black heart bursts for 80, stacked with items like Ceremonial Robes
- Squishy insurance: the Lost family takes Missing Page 2 as one extra "near-death screen clear" (which synergizes with Holy Mantle's damage logic)
Frequently Asked Questions
What is A Missing Page in Isaac?
A trinket: chance on hit to trigger the Necronomicon effect, dealing 40 damage to all enemies in the room. Trigger rate scales with Luck (50% at +50 Luck).
What does Missing Page do?
The umbrella name for A Missing Page (40 screen-wide damage on hit) and Missing Page 2 (near-death 40/80 damage + black heart buff). Different triggers, same Necronomicon-damage source.
What is the difference between Missing Page 2 and A Missing Page?
A Missing Page (trinket): probabilistic counter-damage that scales with Luck. Missing Page 2 (item): one automatic near-death proc + doubles black heart explosions to 80. One is chance, the other is insurance.
How do you trigger Missing Page's effect?
A Missing Page: take damage and it has a chance to trigger (stack Luck to raise it). Missing Page 2: drops to 1 heart after damage and it auto-triggers; black hearts burst for 80 when consumed.
Is Missing Page worth taking?
Both, yes: A Missing Page is free counter-damage for high-Luck builds; Missing Page 2 is near-death insurance plus the black heart buff for squishy characters. Need survival? Take 2. Stacking Luck? Take A.
Related Guides
- The Binding of Isaac Rebirth Items — the item system and pools
- Isaac Items Cheat Sheet — quick lookups
- Binding of Isaac Story — Full Narrative, 23 Endings and Lore
- Isaac Spindown Dice Guide — Best Item ID Conversions
- Binding of Isaac Characters — Unlock Guide & Tier List
Last updated: August 12, 2026.
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