The following fix has been mentioned Elsewhere (But not at length).

The microstuttering cause by the Fallout New Vegas engine can be greatly reduced/resolved by setting your monitor refresh rate to 64hz. This can be done through your Nvidia Control Panel by setting up a customized monitor resolution and refresh rate.


Warning:

If you do not know what your doing, messing with your monitors refresh rate can damage your monitor.

http://www.newvegasnexus.com/downloads/file.php?id=34832 also fixes this issue with the added bonus of being able to run at 50hz or 75hz with no microstutter.

Unfortunately not all monitors can run 64hz, my old Viewsonic could but my Dell absolutely refuses.

The fix requires a decrypted exe. Isn't that against the eula? And more importantly, how has the mod community fixed this when Bethesda hasn't?