Start by boiling the elbow macaroni in a large pot following the package directions. Once cooked, drain and set aside.

Fry the bacon strips in a skillet over medium heat until crispy. Place them on paper towels to drain, then crumble into small pieces.

Using the same skillet, cook the ground beef over medium-high heat until no longer pink. Drain excess fat if necessary.

Add diced onions to the skillet with the beef and cook until softened. Mix in ketchup, mustard, Worcestershire sauce, salt, and pepper. Let flavors blend for about 2 minutes.

Lower the heat slightly, then stir in shredded cheddar cheese until melted. Gently fold in cooked macaroni and crumbled bacon.

Lay tortillas flat and evenly divide the cheesy beef and macaroni mixture among them. Add shredded lettuce, tomato slices, and pickles if desired.

Roll up the tortillas snugly around the filling, slice in half, and serve warm.