Some survivors are having to sleep in tents after their homes were destroyed
Security forces have been deployed to help rescue efforts in the rugged districts of Jajarkot and West Rukum, 500km (310 miles) west of Kathmandu.
Strong tremors were felt far away in the Nepalese capital and in cities in neighbouring India, including Delhi.
The government said about 375 people had been injured. Jajarkot's hospital is packed with the wounded.
Some people have had to be airlifted as far as Kathmandu, but officials are worried about getting others out after nightfall.
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