Which version of Windows you are running.
Unless you are running W98, Me, or XP, forget about high level gaming. NT and W2K don't support many game functions.
That said, most of "tweaks" that improve game performance will be made in BIOS settings, or device driver settings, and will for the most part be global changes.
All gaming performance tweaks are trade-offs between speed and stability.
Tweaks that improve game performance will improve performance of other applications.
My personal recommendations are:
1. For W9X/Me tripple your RAM.
For XP, max out the RAM that the motherboard can handle.
Choose your RAM carefully, if your motherboard supports adjusting the CAS Latency setting, search for and purchase CL2 RAM. (performance is optimized if all DIMMs are the same)
2. BIOS settings:
Verify AGP mode is set to support the speed of your card (1x, 2X, 4X)
Adjust the AGP apperature to 1/2 of system RAM.
Disable any hardware that you do not use. I/R ports, serial ports, etc.
Verify memory settings are the fastest supported by your RAM.
3. Keep drivers up to date.
AGP mini-port driver for the motherboard, Video card driver, DirectX.
4. Download a DirectX control panel.
This will allow you to adjust hidden DirectX settings.
I think you can find one at www.voodoofiles.com
As to user profiles, the best benefit of having a "gameing" profile, is that you could:
Minimize the number of tray and back-ground programs that load automatically. This will free up a lot of resources.
(If you won't be on-line, or network gaming, you can skip running the anti-virus and firewall programs.)
You may even be able to skip installing device drivers that you do not need for gaming. (CD-RW drive software, printers, scanners and such)
Chas