This study investigated the rate of helmet use among motorcycle drivers and passengers in Kathmandu, Nepal during the Fall of 2016, and compared helmet use rates based on highways, main roads and secondary roads in the city. The study design involved cross-sectional observations along roadways in Kathmandu, Nepal. The following variables were studied: helmet use, gender, age category (youth, adult, elder), and type of road (highway, main road, secondary road). Statistical analysis included general behavioral prevalence, relationship comparison via Fisher’s Exact Test, and odds ratios. A total of 1878 observations were made at 14 locations in Kathmandu; n=1321 observations of motorcycle drivers and n=557 observations of motorcycle passengers. Nearly all drivers used helmets (0.994 [1313/1321]; 95% CI: [0.988, 0.997]), whereas the vast majority of passengers did not wear helmets (0.014 [8/557]; 95% CI: [0.004, 0.021]). Helmet use was significantly different between drivers and passengers (