The 5.6-magnitude quake hit the far west of the Himalayan country late on Friday and was measured by the US Geological Survey at just 18km deep.
Videos and photos posted on social media showed locals digging through rubble in the dark to pull survivors from the wreckage of collapsed homes and buildings.
Mud houses were flattened or damaged as survivors crouched outside for safety, and the sirens of emergency vehicles wailed.
The quake was felt as far away as India’s capital New Delhi, nearly 500km from the epicentre, 42km south of Jumla.
“The death toll has reached 119 and at least 100 have been injured,” Karnali Province police spokesman Gopal Chandra Bhattarai told AFP.
“The remoteness of the districts makes it difficult for information to get through.”
Bhattarai said Nepali security forces had been deployed extensively to assist with search and rescue operations.
“Some roads had been blocked by damage, but we are trying to reach the area through alternate routes,” he added.
The district hospital was packed with residents bringing in injured victims.
‘Human and physical damages’
Nepal lies on a major geological faultline where the Indian tectonic plate pushes up into the Eurasian plate, forming the Himalayas, and earthquakes are a regular occurrence.
“We have information that there have been human and physical damages in two districts because of the quake,” said home ministry spokesman Nararyan Prasad Bhattarai.
Nepalese prime minister Pushpa Kamal expressed “his deep sorrow over the human and physical damage caused by the earthquake”.
Nearly 9,000 people died and more than 22,000 were injured in 2015 when a 7.8-magnitude quake struck Nepal, destroying more than half a million homes.
It damaged or destroyed nearly 8,000 schools, leaving almost one million children without classrooms.
Hundreds of monuments and royal palaces – including the Kathmandu Valley’s Unesco World Heritage sites – that had drawn visitors from around the world were destroyed, in a major blow to tourism.
Six people died in November last year when a 5.6-magnitude earthquake struck Doti district, near Jajarkot.
Indian social media users reported feeling Friday’s quake in the northern cities of Lucknow and Patna.
It was followed several hours later by an aftershock in the same area with a 4.0 magnitude, USGS said.