Preheat your oven to 350°F (175°C).
In a large skillet over medium heat, cook the ground beef, onions, and garlic until the beef is browned and the onions are tender, about 5-7 minutes.
Stir in the diced tomatoes and Worcestershire sauce; let it simmer for about 3-5 minutes to combine the flavors.
Meanwhile, cook the elbow macaroni according to package instructions until al dente; drain and set aside.
Add the cooked macaroni to the skillet mix and stir to combine all ingredients evenly.
Transfer the mixture to a greased 9x13 inch baking dish and sprinkle the top with shredded cheddar cheese.
Bake in the preheated oven for 20-25 minutes, or until the cheese is melted and bubbly.
Optionally, top with diced pickles just before serving for added crunch and tang.
