Do you mean the Pain skull? First it gives +2 attack +50% rage in combat but takes 1/2 mana at start of combat. It's not random. The zombie gave it to me(After I poured holy water over it's half-eaten brains.) after correctly doing the witch/alchemist quest. Otherwise you can't talk to him at all. Got it both my current and my previous game. There's a few more of these items like Isshara's whip gained from a quest in demonis, or the Miner Helmet in... the small dwarven land with the broken thunder can(Obviously can't remember it's name =).
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