Although the Himalayan range is classically presented as cylindrical along strike, segmentation of the range in terms of structure, topography, precipitation, and erosion patterns is becoming widely recognized. The potential climatic or tectonic controls on these lateral variations remain controversial. Thermokinematic models predict that the geometry of the main Himalayan detachment controls the kinematics, exhumation, and topography of the orogen: where the detachment includes a major crustal ramp, the topography shows a steep gradient that focuses orographic precipitation and exhumation, whereas the topography is gentler and exhumation less focused above a flatter detachment. We test this prediction by comparing the patterns of river incision (specific stream power) and long-term exhumation (from apatite fission track thermochronology) in central Nepal, where a major crustal ramp has been imaged by geophysical methods, with new exploratory data from the remote Karnali River transect in western Nepal, where a ramp is predicted to be absent or minor. Our results show that both exhumation rates and river incision capacity are significantly higher and focused on the crustal ramp in central Nepal, whereas they are lower and the pattern is more diffuse in western Nepal. These differences support a model in which lateral variations in topography and exhumation are controlled by variations in the geometry of the detachment, and imply that along-strike climatic variations in the Himalaya respond to tectonics rather than driving it.