It attacks primarily with fast, spreading bullets fired in rapid succession and by chasing the player around, always followed by a four-way Brimstone blast. The Fallen can be difficult if encountered early in the game or when damage output is low.Fortunately, it drops A Pony on death, which sets your current speed to a respectable value, grants flight, and can activate a Dash Attack that deals decent damage. What's even worse is that this guy has potential to be the very first boss in a run. The head also appears as a Degraded Boss, sometimes more than one at a time. The charges will cover top, middle, and bottom, and not always in the same order. The body shoots bombs that leave blood creep constantly, while the head shoots bullets with barely any warning and charges frequently. The Headless Horseman is a Dual Boss that combines the strategies of the four Horsemen.After you've damaged him enough, his mount detaches with its own health and charges endlessly, even after you've killed him. He can also slow you down with an Hourglass effect, making it harder for you to avoid his Scythes (and, if you're unlucky enough to face him alongside another boss in Boss Rush or War in Mega Satan's fight, the other boss' attacks, too). It's limited homing, but they are big and hard to dodge.

Death, the final Horseman, is able to summon Scythes that home in on you.

He's even worse in Rebirth, as his ipecac blasts are faster. but good luck getting to his second stage on more than a heart or two. Once you get to his second stage, it is easy. Unfortunately, he is spawning grubs all over, and he has a sudden tendency to rapid fires his ipecac blasts. Fortunately, his ipecac blasts will clear the rocks out eventually. The rocks and holes in the arena limit mobility, and his ipecac shots cover the floor with toxic green creep.

Pestilence is mostly a pain because of room design more than anything else.

The binding of isaac rebirth boss rush