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Like the poster above me mentioned, try turning both shadow options to their lowest settings and turning god rays completely off. They are known to tank and kill fps. I'm running FO4 on a laptop so you probably have better specs than I do so probably wouldn't hurt to look into overclocking your processor. Only do the last one if you're familiar with overclocking. Performance mods might help too if it isn't a real serious issue.
(Just throwing this last one out there, make sure all your drivers are up to date and might help to go into your nvidia panel and mess with settings in there like vysnc and performance options, cliche, I know).
Not to rag on Windows 10 but I've been seeing that it's been the culprit for some people having performance issues, concerning games and not just FO4 but you can probably take this with a grain of salt because I won't say that it's 100% concrete since everyone's system is different.
Unless you haven't had these issues previously then you could try downgrading to an earlier version of Windows like 8.1 if you're really desperate and see if that does anything. Only other thing I could say is that it's an overheating issue which is known to cause drops in framerate due to throttling.
You could turn shadow distance down or you could download a mod called Shadow Boost that will adjust the shadow distance dynamically in real time for when the FPS takes a nosedive.
Also set your Fallout4prefs.ini yourself with Notepad,
Change
Ipresetinterval=1
to
Ipresetinterval=0
Then open your main graphics panel and set up for Vsync through it.
It's to do with your monitor refresh rate 75hz and your capped at half refresh rate.
Check settings in Nvidia Control Panel.
You could try this.......... (Just found it googling your problem)
Find Fallout4Prefs.ini (C:\Users\Documents\My Games\Fallout4)
Open it and edit.
iPresentInterval=1 --- V-Sync with 60 fps lock.
iPresentInterval=2 --- V-Sync with 30 fps lock.
iPresentInterval=0 --- Dis V-Syns, unlim fps. <<< I would suggest this, and see what happens.
Well ok. That worked. Thanks a bunch!
So what's your fps ?
Well if you lower shadow and godrays quality (If you haven't already), you should get it a bit higher.
What weird is that when i start up the game again to change settings the iPresentInterval= goes from 0 to 1. So i have to change it everytime.