Try this:
Find your falloutPrefs.ini file and create a backup copy (always create backups when manually editing the ini files), open the original and go to the [controls] section, and add the following lines to the section:
fForegroundMouseAccelBase=0
fForegroundMouseAccelTop=0
fForegroundMouseBase=0
fForegroundMouseMult=0
That has helped a lot of people with mouse lag issues but also take a look at some general performance fixes below.
Here are some common tweaks for performance:"Game Stutters / Lags Randomly" (NOT NVIDIA-Specific, Look at Next Game Solution)
This issue seems most common with NVIDIA graphics cards, though it is reported that some ATI graphics cards are having the issue too. This usually happens when multiple NPC's are nearby or after killing something. It isn't related to having a low-end system, as even some high-end systems have this problem. This is a "general" fix attempt. Look at the next solution for one specific to NVIDIA.
1. Upgrade your graphics card drivers (NVIDIA and/or ATI) to the latest version. These generally provide performance enhancements for specific games, as well as fixes.
2. Turn off kill cinematics (very much optional)
3. When possible, apply the latest patch for the game
Again, if you are using a NVIDIA card, first follow the fix listed below, and if that doesn't work then try the steps listed in this one.
"Game Lags and Stutters / Choppy Graphics or Frame Rate / FPS - With NVIDIA Graphics Card"
So, unlike the above game fix, this is aimed specifically to help those with NVIDIA video cards. Note that if you do NOT have this issue, it has been reported that older drives don't have this problem with the game, and that newer drivers do play the game without issue at this given time (October 19th, 2010). This WILL be fixed so don't feel as if you will never be able to update your drivers again. On the contrary, as mentioned above, it will improve your performance eventually once more updates come out.
1. Add a custom NVIDIA Game / Applications profile for "Fallout: New Vegas"
2. For that profile, change the "Power Management" from "Adaptive" to "Max Performance"
That *should* fix your problem. For those having trouble locating this feature, go to--
My Computer -> Control Panel -> NVIDIA Control Panel -- and it's under "Manage 3D Settings".
Fallout: New Vegas - NVIDIA Power Management Lag Fix
It is reported that this option is "Available only for the GeForce 9 series and above".
"Game Lagging / Stuttering Fix From Direct-X?" (This helps most people quite a bit- to the point where many other fixes are not even required)
This is the same fix as the above DLL crash fix method. Some of you may not be crashing from not having this DLL, but instead may be suffering lag and game stuttering.
1. Download the dx9d9.dll: http://www.newvegasnexus.com/downloads/file.php?id=34778 (Nexus)
2. Put the file in your Fallout: New Vegas folder
"I Am Still Lagging! What Else Can I Try?"
(Generally not recommended. Consider this as a last resort!)Bummer! You can attempt to modify your Fallout.ini file yet again to combat this. This method makes use of VSYNC.
1. Load your Fallout.ini file and make sure that it is NOT Read-Only
2. Make the following change and then save--
iFPSClamp=0 to iFPSClamp=60
"Is There Anything Else I Can Do to Stop This Lag!?"
Yes! One of our users commented on a method that has helped him and many others stop their lag.
1. In your console type in ToggleEmotions
You'll have to type this in every time you play the game, but as I said, it fixes the problem for many. Thanks Auutumn!
"Is There a Way to Help Lessen the Lag?"
One of our visitors just posted a great tip on how to help lower the amount of lag being experienced. Thanks gr0x!
1. Right Click Falloutnv.exe -> Properties -> Compability -> Check "Disable Visual Themes"